* 1. What is your age?

* 2. Are you male or female?

* 3. In which era did you serve? Please select all that apply.

* 4. Do you have a VA-rated Service Connected Disability?

* 5. Nature of illness/injury (choose PRIMARY one)?

* 6. How many years have you had this illness/injury?

* 7. Do you use a wheelchair or prosthetic limb on a daily basis?

* 8. Which of the following VA National Veterans Sports Programs & Special Events have you participated in, if any? Please check all that apply.

* 9. For how many years have you participated in any VA National Veterans Sports Programs & Special Events?

* 10. For how many years have you participated in the National Veterans Wheelchair Games?

* 11. How often do you participate in sports activities?

* 12. How do you engage in sports and recreation programs? Please check all that apply.

* 13. Which of the following, if any, does your VA therapist do to support your participation in sports and recreation at home? Please check all that apply.

* 14. For how many months, if any, did you train in preparation for this event?

* 15. How likely are you to continue involvement in one or more of these sports when you return home?

* 16. Please indicate the extent to which you agree or disagree with the following statement: "Preparation and participation in the National Veterans Wheelchair Games will teach me ways to be active in recreation in my home community."

* 17. To what extent would each of the following help you to be more involved in sports on a regular basis? Please use the following rating scale:

  Would not help Some help A fair amount of help A lot of help A tremendous amount of help
Education of community programs available in my area
Adaptive sports clinics to develop skills
VA staff support to introduce me to a local program for the first time
Adaptive equipment

* 18. Thinking specifically about this event, what is the SINGLE most important reason you are participating in this event?

* 19. When you participate in leisure activities, do you usually do this alone or with others?

* 20. To what extent did each of the following influence your decision to participate in this event? Please us the following rating scale.

  No impact Slight impact Moderate impact Major impact
My doctor or therapist recommended it
I enjoy sports
I am an active person
I am concerned about staying healthy
I like to compete in sports events with other Veterans
I like the interaction with other Veterans
I want to gain experience with different sports
My friend or family member encouraged me to participate

* 21. What division are you competing in?

* 22. How is your participation in the Wheelchair Games funded? Please select the PRIMARY source.

* 23. At the Wheelchair Games, I will participate in 1 or more sports I did prior to my injury/illness.

* 24. Following participation in the Wheelchair Games, my goal for sports involvement is (please rate in order of importance):

* 25. Because of the Wheelchair Games, I have become aware of sports opportunities for me.

* 26. Because of preparation for the Wheelchair Games, I exercise more frequently.

* 27. As a result of participating in the Wheelchair Games, I hope to:

  Strongly Agree Agree Neither agree nor disagree Disagree Strongly Disagree
know more about adaptive sports, resources and opportunities.
feel more independent.
be motivated to be more involved in sports and recreation.
overcome barriers to participate in activities I want.

* 28. Is there any other feedback you'd like to provide?