Veterans National Symposium

<%@LANGUAGE="JAVASCRIPT" CODEPAGE="1252"%> Veterans National Symposium - Survey

Thank you for participating in our veterans benefits survey! Your feedback will help us develop an effective format for the National Symposium for the Needs of Young Veterans. This survey is comprehensive, so please allow several minutes to complete all sections.

Your privacy is our highest concern and we are committed to keeping your answers confidential (although answers may be tabulated with others in a report or discussion during the Symposium). AMVETS will not sell or distribute your contact information to any third parties. For more information about our privacy policy, please read our privacy statement. Thank you again for your invaluable feedback.

Age
Branch of service
Dates served (month/year)		—
Did you serve in combat?		Yes No
Gender		Male Female
Are you married?		Yes No
How many times have you been married?
Do you have children?		Yes No
Why did you join the Armed Forces?
Do you have a promise of employment or a job waiting for you?		Yes No Not Applicable
Are you currently employed?		Yes No
Please list the type of work you have done over the past five years
Are you currently seeking employment?		Yes No
If ‘Yes,’ what method are you using?
Have you ever been referred to an employment training program?		Yes No
If ‘Yes,’ did you attend?		Yes No
If ‘Yes,’ please list the type of training (e.g., résumé, computer, etc.)
If you are not presently employed, are you not working due to disabilities?		Yes No
What comments can you offer regarding your individual employment issues?
When you discharged from the military, did you attend the Transition Assistance Program?		Yes No
Do you think that the Transition Assistance Program prepared you for civilian life?		Yes No
If you were not satisfied with the Transition Assistance Program, what would you like to see added.
If you attended Transition Assistance, was a member of a service organization (e.g. AMVETS, VFW, American Legion) in attendance to help you file a claim for VA benefits?		Yes No
If you retired from the military, was Concurrent Receipt explained to you in all cases if you were/are service connected for a Veteran Affairs disability?		Yes No
What is your highest level of education (grade or degree)?
In what geographic area of our nation will you reside?
Were you ever treated for any injury/disease/medical/psychological problems during your service?		Yes No
What do/did you expect of your service to our nation?
Are you receiving VA disability compensation or pension?		Yes No
If ‘Yes,’ are you receiving more than $847 per month?		Yes No
If ‘No,’ have you ever filed for VA disability compensation or pension?		Yes No
What comments can you offer regarding VA disability compensation or pension?
Are you receiving Social Security disability?		Yes No
If ‘Yes,’ are you receiving more than $580 per month?		Yes No
If ‘No,’ have you ever filed for Social Security disability?		Yes No
What comments can you offer regarding Social Security disability?
Do you use the VA for all your medical care?		Yes No
If ‘No,’ where else do you receive medical care?
Which VA healthcare services do you use (check all that apply)?		Primary Care Speciality Clinics Mental Health Other
What other VA healthcare services do you use?
How do you rate the overall quality of care you receive from the VA?
What comments can you offer regarding your experience with VA healthcare?
In what city and state does your nearest relative live?		City State:
Are you still in contact with family member(s)?		Yes No
When did you last speak to or write a family member?
Do you have any comments you can offer regarding your family?
What one or two issues, important to you, do you think people should know about?
Would you like to speak to a veterans service officer regarding this survey?		Yes No
OPTIONAL INFORMATION:
Name
Street Address
City, State, ZIP Code
Phone Number
E-mail


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