Orange County Survey for Ask The Questions Campaign

Question Title

* 1. Is your agency:

Aging & Senior Services

Children's Services & School Systems

Employment & Vocational Services

Faith-Based Groups

Health Care & Medical Services

Higher Education & Adult Learning

Housing & Homelessness Services

Law Enforcement & first Responders

Legal & Advocacy Services

Mental Health & Substance Abuse Services

Social Services- Federal/State/Local/Non-Profit

Women's Services & Crisis Centers

Domestic Violence and/or Sexual Assault

Other (please specify)

Question Title

* 2. Organization Name

Question Title

* 3. Estimated number of people you/your agency serve each year? (if it is not known. leave blank)

Question Title

* 4. Do you/your agency have a way of identifying clients as serving in the military, service members, veterans and/or military connected family members, including children? (Please check all boxes that apply)

I/We ask “Have you or a family member ever served in the military?”

I/We ask “Do you have children?”

I/We ask “Are you currently serving in the military?”

I/We ask “Is there anyone in your household serving in the military?”

I/We ask “Are you a veteran?”

I/We ask “ Is anyone in your household a veteran?”

I/We do not ask at all

I/We don’t know

Other – please specify below with what you ask. Details of what you ask/how you ask it:

Question Title

* 5. On a scale of 1-5, how familiar and comfortable are you/ your agency with identifying the needs of and corresponding resources for service members, veteran and veteran families?

1- NOT AT ALL familiar and comfortable

2- MINIMALLY familiar and comfortable

3- SOMEWHAT familiar and comfortable

4- FAMILIAR and COMFORTABLE

5- VERY FAMILIAR and COMFORTABLE

Other (please specify)

Question Title

* 6. On a scale of 1- 5 what is your agency's level of interaction / collaboration with other military and/or veteran-specific State, County and local resources?

1- NOT AT ALL connected

2- MINIMALLY connected

3- SOMEWHAT connected

4- CONNECTED

5- VERY CONNECTED

Other (please specify)

Question Title

* 7. Would you/your agency like to receive FREE military/ veteran family culture training?

Yes

Question Title

* 8. Would you/your agency like to receive FREE flyers targeted to service providers on how and why to ask the appropriate questions? Please indicate which:

Aging & Senior Services.

Children’s Services & School Systems.

Employment & Vocational Services.

Faith‐Based Groups.

Health Care & Medical Services.

Higher Education & Adult Learning.

Housing & Homelessness Services.

Law Enforcement & First Responders.

Legal & Advocacy Services.

Mental Health & Substance Use Disorders Services.

Social Services – Federal/State/Local/Non‐Profits.

Women’s Services & Crisis Centers.

Other (please specify)

Question Title

* 9. Would you/your agency like to receive more information and education regarding resources and referrals for veteran clients, military connected families, customers, patients or employers who answer "yes"?

Yes

Question Title

* 10. If you are interested in receiving training on any of the above topics, please indicate the topic, your organization and contact name and your email.

Question Title

* 11. Would you like to learn more about the Orange County Veteran and Military Families Collaborative (OCVMFC) which is a coalition of service organizations that facilitates access to comprehensive services for veterans, service members and their families?

Yes, please send me more information.

No, I am already a member.

No.

Other (please specify)