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PVA leadership wants and needs to hear from you in order to better serve you and other members.

We will not solicit you or sell your information. But we do need your contact information so we can update you on VA and Capitol Hill issues important to our members.  All answers are confidential.

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* 1. What is your first and last name?

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* 2. What is your Race/Ethnicity?

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* 3. What is your gender identity?

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* 4. What is your age?

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* 5. What is your PVA Member number? (Located on your member ID card)

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* 6. What is your current contact information?

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* 7. What Chapter are you a Member? (select one answer only)  If you don't know what chapter you belong to, look at your membership card as it's listed there!

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* 8. Please select all of your disabilities and conditions (please check all that apply):

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* 9. Are you service connected for your SCI/D?

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* 10. Are you service connected for any other disability?

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* 11. Do you use any of the following assistive devices for mobility? (Check all that apply)

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* 12. Do you depend on the services of a caregiver or attendant?

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* 13. Do you receive home and community based services through any of the following VA programs:

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* 14. Do you receive long-term care at one of the following facilities:

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* 15. Do you do any of the following? (Please check all that apply)

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* 16. Do you receive any of the following benefits? (Please check all that apply)

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* 17. Where do you receive your SCI/D care?

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* 18. Have you experienced gender-based harassment in accessing care?

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* 19. Within the past two years, have you experienced any accessibility issues in the following places: (Please check all that apply)

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* 20. How often do you encounter an architectural barrier (broken sidewalk, no ramp, narrow aisles, etc.) in your community?

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* 21. What PVA National Programs have you engaged with (select all that apply):

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* 22. What PVA National Programs would you like to engage with (select all that apply):

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* 23. If there are PVA National programs you’d like to engage in but don’t, why is that?

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* 24. How many hours a month do you engage with your chapter (i.e. governance, events, membership meetings, committee meetings, etc.):

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* 25. If you are not engaged with your chapter, is there a reason why you are not involved?

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* 26. Have you been sexually harassed or assaulted while at the VA in the last 3 years.  (REMINDER - your answers are confidential)

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* 27. What areas would you like PVA to put more focus on (Rank in order of importance with #1 being the top focus)  ALL topics MUST be ranked / checked NA otherwise you can NOT move forward in the survey. 

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* 28. Is there anything else you would like to share in order to improve support provided to members?

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