Domestic Violence and Sexual Assault Survey

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* 1. What is your name?

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* 2. What age range are you?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 3. What is your gender?

Male

Female

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* 4. What is your race or ethnicity?

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Another race

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* 5. What is your relationship status currently?

Single

Married

Divorced

Significant Other

Dating

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* 6. Do you have any dependents?

Spouse

Children

Parents

Family member

Other

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* 7. What is your highest level of education?

GED

High School

College

Vocational

Other

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* 8. Are you currently employed?

Yes

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* 9. What is your current income?

none

less than $20,000

$21,000-$30,000

$35,000-$40,000

$41,000+

Prefer not to answer

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* 10. Have you served in any branch of the United States Military?

Army

Marines

Navy

Air Force

National Guard (Gen)

Space Force

Coast Guard

None of the above

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* 11. What is your duty status?

Active

Retired

Veteran

Reserves

Other

Not applicable

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* 12. If applicable: How would you describe your overall transition from active duty to veteran status?

Very Smooth

Smooth

Neutral

Difficult

Very Difficult

Currently Active

Not applicable

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* 13. What was the biggest challenge that you faced when transitioning out of the military?

Loss of identity/purpose

relating to nonveterans/Reintegrating with Community

Readjusting to social life

Health concerns

Finding/Keeping Employment

Isolation from Unit/Service Members

Not Applicable

Other (please specify)

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* 14. How many years have you served?

1-4

5-10

11-15

16-20

21+

Not Applicable