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Share Your Story!

We want to hear about the people, services and supports that make a difference in your life. Tell us about a Care Manager, CDNY team member, service provider or other supports or activities that help you live the life you choose, and why Home and Community-Based Services (HCBS Waiver services) and Medicaid are important to you.

Your story can help show why these services matter, how changes to access to Home and Community Bases Services and Medicaid could affect you and why the rights protected by the DOJ’s Olmstead decision are important.

Your story may be featured in CDNY email newsletters, on our website or social media and shared with local and/or national advocacy groups such as ANCOR and the ARC of the US and others advocating for the rights of people with I/DD.
Please note: Your name an email address are required for security purposes only and will not be used in your submission or to contact you.
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Care Design NY Media Release and Authorization

By signing this form, I understand that I am providing consent and authorization for Care Design NY to take and use photo imagery, audio, video image, and/or testimonial (with or without the use of the person’s first name) in perpetuity. This will allow Care Design NY to take and use photo imagery, audio, video image, and/or testimonial for internal or external communications for the purposes of education, advertising, marketing, publicity, and/or fundraising. Use could include distributing materials on the website, in email newsletter, social media, TV, radio, news releases for the media, and/or print publications such as newspapers, magazines, and Care Design NY publications (brochures that are provided to the general public). I also give permission, if interviewed, by Care Design NY or its affiliates to use the story, and any of the direct quotes in any medium, including descriptive details that individual chooses to share about their life with Care Design NY.

By signing this form, I understand and agree to the following:

1. Giving consent will publicize that services are provided to the individual by Care Design NY.

2. Care Design NY will retain all rights to the photographs, moving images, sound recordings, and other media, and that there will be no compensation by Care Design NY.

3. I waive any right to inspect or approve media that contains my name, image, sound recordings, story, and/or information.

4. I will not assert any claim of any nature against Care Design NY, its employees and agents, and/or affiliate programs relating to the exercise of the permissions granted by this Release and Authorization.

5. I understand and acknowledge that the Internet allows for wide sharing and forwarding of information and that CDNY cannot control all reproduction and/or re-disclosure of information.

6. The photo imagery, audio, video image, and/or testimonial obtained during the period of this authorization may be utilized indefinitely. This authorization will remain in effect until the person supported by Care Design NY (identified above) is discharged at which time no new photos, audio, video or testimonials obtained from that date forward may be used.

7. I may revoke this Release and Authorization at any time, in writing, but a revocation, or discharge, will not impact any use or disclosure made prior to the date the revocation is received or discharge has taken effect.

8. I understand that I have read this document (or it has been translated to me), I fully understand it, and my consent is made knowingly and voluntarily. I am signing this Release and Authorization voluntarily and understand that provision of services to me by Care Design NY and/or its affiliate programs is not conditioned on whether or not I sign it.
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