GrapeVine Participant Story

Thank you for being willing to share your story with us!

Your story can inspire other individuals who are going through a similar experience.
Your experience also helps us shape our program in a way that is most helpful to the people we serve and better understand challenges individuals face.

You might consider sharing things like:

What motivated you to attend a GrapeVine session?
How did the information presented improve/impact your life?
Do you have advice for others who could benefit from participation in a GrapeVine session?

1. Please share your first and last name (example: Jane Doe). *This question is required.

2. Enter story here:

3. A picture is worth a thousand words! Please submit your photo here:

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4. I hereby give the WWHF consent to share my words and/or image. My words and/or image may be used in the following ways: Print material, E-newsletter, Social media/blogs posts/online, and/or reports. I further understand that no special compensation will be provided to me (beyond the gift card I receive for sharing my story today) and that I may not be informed in advance of the specific use of my words or image.

If you agree, type your name below: *This question is required.

5. How would you like to be identified?

Please enter an 'other' value for this selection.
Please enter an 'other' value for this selection.

6. Date Completed This question requires a valid date format of MM/DD/YYYY.

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7. Please enter your email address below (example: janedoe@gmail.com). *This question is required.

8. Please enter your phone number below (example: 111-222-3333). *This question is required.