Share Your Story: 30 Stories for 30 Years

Section 1: Your Contact Information

So we can follow up with you about your story.

First Name:(Required)

Last Name:(Required)

Email Address:(Required)

Phone Number:

City / Town:

Section 2: Your Connection to Hearth Place

Tell us how you are part of the Hearth Place community.

How are you connected to Hearth Place?(Required)

How long have you been connected to Hearth Place?

Which Hearth Place programs or services have you been part of?

(e.g. support groups, wellness programs, grief support, volunteer programs)

Section 3: Your Story

A few sentences are all we need to start the conversation.

In a few sentences, what is your story?(Required)

Tell us about your experience with Hearth Place. What brought you here? What mattered most? What would you want others to know?

Is there a specific moment or experience that stands out for you?

A particular day, conversation, milestone, or turning point that captures what Hearth Place means to you.

What does Hearth Place mean to you?

In your own words, what has Hearth Place meant in your life or the life of your family?

Does your story connect to a particular theme?

Section 4: How Would You Like to Share?

Stories can be shared in different formats. Tell us what feels right for you.

Which formats would you be comfortable with? (Check all that apply)(Required)

Written profile (an article or feature based on your story)

Short video (filmed interview or conversation)

Podcast or audio interview

Social media post (a shorter, shareable version)

I am not sure yet. I would like to discuss this with the team.

Would you be willing to share a photo of yourself for use with your story?

Yes

Maybe, let's discuss.

Section 5: Consent and Permissions

How your story will be used:

If your story is selected, it may be shared on the Hearth Place website, social media channels, email newsletters, and in print materials as part of the 30th anniversary campaign. Your story may also be archived in the Hearth Place story library for future use.

Your control:

You can withdraw your consent at any time by contacting Hearth Place. If you withdraw consent, we will stop using your story going forward, though we may not be able to remove content that has already been published.

Sensitivity:

We understand that many stories involve cancer, loss, and grief. Our team will work with you at your pace and will never pressure you to share more than you are comfortable with. You can review your story before it is published.

Please check each box to confirm:(Required)

I give Hearth Place permission to use my story as described above, and I understand a team member will follow up with me to discuss details and confirm consent before anything is published.

I agree to be contacted by a member of the Hearth Place storytelling team about my story.

I understand that sharing my story may involve discussing sensitive topics related to cancer and loss, and I am comfortable proceeding with this conversation.