Utah Children

Story Banking

Voices for Utah Children is gathering stories about families’ experiences using CHIP.

Voices for Utah Children plans to share these stories with local leaders and policy makers to help them better understand and support the CHIP program.

If you would like to share your CHIP story, please contact: Jerry Cochran at—(801) 304-5031 (Salt Lake County) or 1-877-445-2447 (Toll Free). Or, if you would like to share your story electronically, please fill in the form below.

Voices for Utah Children believes your story can have an impact on policy makers to help them better understand and support CHIP. Please share your story now; it will make a difference.

Disclaimer:
Thank you so much for expressing interest in sharing your CHIP experiences. This is a completely voluntary activity and you are under no obligation to participate. The information that you provide may be used in various ways to tell others about CHIP including, the CHIP website, news releases and others.

Would you like to remain anonymous if your story is used and released to the public? Yes No

Questions:
Please tell us about your family (50 words):


The next questions are about your experiences before enrolled in CHIP.
Please tell us about your experiences before your children were insured (100 words) :

How did not having health insurance coverage make you feel (100 words) :

Did the choices you make about spending money create stress within your family (100 words) :

Did your children ever need to see a doctor or require medical attention while they were without coverage (50 words) :

Did your family have a regular doctor before CHIP (50 words) :


The following questions are about your experiences while enrolled in CHIP.
How did you find out about CHIP :

What was it like trying to enroll your family in CHIP :

What has been your experience while on the program :

What has it meant to have your kids covered (50 words) :

Do you have any suggestions of how CHIP could better serve other families (100 words) :


Additional required information:
If you opted to remain anonymous, please still provide the following information for our records. We will not release your personal information without your consent.
Full Name :
Address :
City :
State :
Postal Code :
Home Phone :
Mobile Phone :
Work Phone :
Email Address :
Age :
Approximate household income or net business income for small-business owners (can provide a range) :

Marital status :

Number of children, their age, name, gender and insurance status (50 words) :

Employment status (specific occupation, full- or part-time) (50 words) :

Spouse’s employment status (specific occupation, full- or part-time) (50 words) :


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