Thank you for sharing a story of impact with NCOA! Please answer as many questions as possible. Questions? Contact community@ncoa.org
Your Details
Your Name
Story Details
Photo attachments
Please upload any photos or attachments you have related to this story. Photo format must be .BMP, .GIF, .JPG, .JPEG, .PNG, .TIF, .QTF. If submitting photos, please use the space below to identify each person and any instructions about crediting the photographer.
Photo Description
Benefits programs
Low-Income Home Energy Assistance Program (LIHEAP)
Medicare Savings Programs (MSP)
Part D Low-Income Subsidy (LIS/Extra Help)
Supplemental Nutrition Assistance Program (SNAP)
Other
Caregiving
Chronic conditions
Falls prevention
Financial security
Food/nutrition
Job training / work
Medicare / Medicaid
Mental health
Personal finance / budgeting
Scams / fraud
Senior centers
Demographic Details
Male
Female
Non-binary
Prefer not to say
Your state
Are you Hispanic, Latino, or of Spanish origin?
Yes
No
Don't know
What is your race? (Check all that apply.)
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Are you a Veteran?
Are you disabled?
Prefer not to answer
Your birth year
Consent Details
Consent Information
To accept your story, we must ask you to check all of these boxes. It will ensure we can follow up with you if needed and understand your preferences about whether we can share your story.
I declare that the information provided by me is true and accurate to the best of my knowledge.
I am at least 18 years old.
I understand that NCOA may contact me about this story via the information I provided.
I am willing to have this story shared publicly via NCOA’s print and online communications.