Thank you for taking the time to complete this short 5-minute survey. We hope you will share your stories and experiences about why Head Start matters to you. Your stories will strengthen our advocacy efforts and help us inform our lawmakers about the importance of Head Start programs and why we must ensure Head Start is not eliminated.

How we will use your story
  • We may or may not tell your full story or share every detail you provided.
  • Additional context around your story may be added to enhance our audiences’ understanding.
  • We may share your story, your image, or parts of your story in multiple formats, including websites, videos, email, digital and print publications, and social media.
  • We strive to represent your story and likeness authentically.  
Our audience includes
  • Other organizations that work with us.
  • Legislators and policymakers.
  • Donors (institutions, companies, and groups of individual supporters) who support our work by providing funding and other resources.
  • Media, including newspapers, magazines, TV, and radio.
  • The public.
Your Rights
  • You have the right to access and update your story.
  • You have the right to change your mind at any time and revoke your consent.
  • If you inform us, we will not use your story in future communications. Please note that we may not be able to withdraw images and stories that have already been published.
  • If you wish for your story to stop being used, or if you have any questions or comments about how your story is being used, please contact us at 518-463-1896.
There is an option below to upload a photo of yourself. If you prefer to email your information or photo directly to us, please send it to amakey@scaany.org.

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Please let us know if we have permission to use your information and photo in our materials by checking all that applies below.

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What is your first name? (Required.)

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What is your last name? (Required.)

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How would you like to be addressed on materials?

For example, "Anonymous provider in Buffalo, NY" or "Full Name, Title"

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