Brain Injury Association of Virginia Personal Story Submission
RequiredRequired Question(s)
Guidelines for Submitting Your Personal Story The Brain Injury Association of Virginia We encourages people with brain injury to share their story and raise awareness!  We hope your story will be a source of inspiration and help others understand their own injuries. We will review all submissions and reserve the right to reject submissions at our discretion; we will not publish stories we consider to be inflammatory or derogatory to anyone.

By submitting this form you are agreeing to:
*grant the Brain Injury Association of Virginia (BIAV) permission to interview me and/or to use my story and/or likeness in any and all of its publications and in any and all other media, whether now known or hereafter existing, controlled by the BIAV, in perpetuity, and for other use by the BIAV.
 *make no monetary or other claim against BIAV for the use of the interview and/or the photograph(s)/video.   
Required 1.

Name. First, Last:


50 characters left.
Required 2.

Email Address:


50 characters left.
Required 3.

Phone Number:


50 characters left.
Required 4.

We are seeking specific types of stories. We will contact you for additional information and details.

 Please tell us about one of the following topics:


Tell us about your or a love one's struggle with homelessness or being placed in an institution or nursing facility due to the lack of appropriate placement or home support options?


Tell us about your or a love one's struggle to get the appropriate help for a concussion?


1000 characters left.