OCB Therapy Survey
AKA The Situation Report (SITREP). Vets Restoring Vets. This form is recording garage time and therapy sessions of Veterans participating in any of our programs when you visit one of our locations. Indiana, Alabama, Illinois, and / or California.
Veterans:
Please fill this out at the end of each visit to an OCB facility or event. This is also tracking your shop hours. If you would like your hours to count toward more benefits in our program please remember to fill out this form.
Name
*
First Name
Last Name
Last 4
*
Last 4 numbers of your SSN
What program did you participate in?
*
Hot Rod Therapy - Sunday Shop Day
Lima Charlie - Veteran Peer Support Group
The JAM Program (music therapy)
F.A.T. Program
Get Lost Outdoor Program
Volunteering
Personal Project
I just needed to get away
Other
Date of participation:
Time IN & OUT
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
30
Minutes
AM
PM
AM/PM Option
Until
until
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
30
Minutes
AM
PM
AM/PM Option
-"BEFORE" your session how did you feel?
-"AFTER" your session how did you feel?
What impact did you make on yourself or others?
*
Please give us your feedback
Submit
Should be Empty: