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Personal Stories for Editorial Social
Name
*
First
Last
Email
*
Phone
City/State
*
Tell us your story
Being gluten-free effects more than just one member of the family. Even if you’re not required to live gluten-free, you might have a story to share. NOTE: The following information is referring to the person whose story you are telling. If you are telling your own story, please use your own information. If you are telling a story on behalf of someone else, please use their information below.
Whose story are you sharing?
My story
My child’s story
My family’s story
Another loved one’s story
How long have you (or your loved one) been gluten-free?
If more than one person in your family is gluten-free, choose based on one person whose story you’d like to share.
A year or less
1-2 years
3-5 years
6-10 years
10+ years
Sex
*
Male
Female
Non-binary
Prefer not to answer
Age Range
*
What was the age of the person in the story?
Parent of child under age 5
Parent of child ages 6-12
Parent of child ages 13-17
Age 18-24
Age 25-34
Age 35-44
Age 45-54
Age 55-64
Age 65+
Briefly share your (or your loved one's) gluten-free story:
*
Tell us more about yourself
What’s your favorite tip for living gluten-free?
Do you find it challenging to afford healthy gluten-free foods?
*
Yes
No
Are you willing to speak to any of these topics? What topic(s) can you speak to (please pick no more than 3):
*
Getting a celiac disease diagnosis
Living with non-celiac gluten sensitivities (NCGS)
Challenging experiences with healthcare providers
Facing/overcoming barriers or challenges to living gluten-free
The emotional side of going and living gluten-free
Stresses of self-advocating with others
Living gluten-free as a young adult (college or post college)
Parenting a gluten-free child
Caring for a gluten-free senior
Tips for others about supporting a person who lives gluten-free
Other
Are there any other gluten-free topics that you would be willing to speak to
*
If you have a website where you discuss living gluten-free, please provide your URL:
If you discuss living gluten-free in social media, please provide links to those accounts:
Life Stage (check all that apply)
*
Parent of young child
Parent of teen
Caregiver to older adult
In college
Young adult
Adult ages 30-50
Older adult age 60+
Has the Gluten Intolerance Group helped to make your gluten-free life easier?
Yes
No
Tell us how
Do you authorize Gluten Intolerance Group of North America GIG) to use your story without payment or any other consideration?
By submitting this information, you are agreeing that all of the above information is provided voluntarily and that you are giving permission for the Gluten Intolerance Group (GIG) to use this information for GIG’s educational purposes, which may include use on GIG’s social media channels, website and other forms of communication. GIG will not use or share this information with any other entities or for any other purposes.
I AGREE, GIG may use my name
I AGREE, but GIG must not use my name
I DO NOT AGREE
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