Survey - Veteran Outreach
Survey Date
-
Month
-
Day
Year
Date
Are you a veteran?
Please Select
Yes
No
What is your relationship to the veteran?
Please Select
Spouse
Child
Parent
Sibling
Relative
Friend
Caregiver
What is the veteran's age?
Veteran's age range?
Please Select
18 – 24
25 – 34
35 – 44
45 – 54
55 – 64
65 – 74
75 – 84
85 – 94
95 – 100
Veteran's branch of service
Please Select
Navy
Marines
Army
Air Force
National Guard
Coast Guard
Space Force
Service Start Date
-
Month
-
Day
Year
Date
Service End Date
-
Month
-
Day
Year
Date
Do you belong to any veteran organizations?
Please Select
Veterans of Foreign Wars
American Legion
Disabled American Veterans
Iraq and Afghanistan Veterans of America
AMVETS
Vietnam Veterans of America
Wounded Warrior Project
None
Other
What is the name of the organization?
What do you feel is the biggest challenge as a veteran?
Please Select
Mental Health
Homelessness
Access to Health Care
Unemployment
Underemployment
Disability / Physical Health Issues
Housing Affordability
Family Strain
Education and Training
Women Veterans' Concerns
Navigating Bureaucracy
Other
If not the veteran please answer from your perspective.
In a few brief words please explain your challenge.
Are there any specific legislative matters you would like the committee to review or propose?
I would like to be contacted for future trainings and events offered by the county.
Yes
No
Veteran's Name
First Name
Last Name
Veteran's Email
example@example.com
1. How much did you enjoy the meeting?
1
2
3
4
5
Please verify that you are human.
*
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