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Governor's Challenge to Prevent Suicide Among Service Members, Veterans and Their Families (SMVF)
Our intent with this survey is to identify what resources our SMVF community currently utilizes and what are the gaps in service from your perspective. Our hope is to provide a way for our military families to access services easily and confidentially. We appreciate you taking the time to complete this survey.
PLEASE NOTE: Information gathered for this survey will be anonymous and will be used only to improve the resource information the Governor's Challenge Team is developing for our Service Members, Veterans and their Families.
*
1.
Please select county where you live:
(Required.)
Addison
Bennington
Caledonia
Chittenden
Essex
Franklin
Grand Isle
Lamoille
Orange
Orleans
Rutland
Washington
Windham
Windsor
*
2.
Current Age:
(Required.)
18-24
25-34
35-44
45-54
55-64
65 or older
3.
Military Affiliation:
Service Member (ARNG, ANG, Active Duty < 3yrs, Reserve, RSP, Cadet)
Veteran ( ARNG/ANG 20+ years retired, combat, Active Duty > 3 yrs,)
Military Family Member
Other (please specify)
4.
Have you accessed mental health support in the last year:
Individual Therapy
Couples Therapy
Family Therapy
Mental Health Crisis Support
Substance Use Treatment
Other Mental Health Support not mentioned above:
5.
Have you experienced any employment or job changes in the last year:
New Job
Better Job
Support on the Job
Looking for a new job
Other:
6.
Have you experienced food insecurity in the last year:
Yes
No
If you answered yes, please expand:
7.
Have you experienced housing issues in the last year:
Yes
No
If you answered yes, please explain:
8.
Have you accessed medical care services in the last year:
Primary Care
Dental Care
Surgical Care
Specialized Care (diabetes, cancer, etc.)
If you accessed other care, please specifiy:
9.
What social media networks do you access on a regular basis:
Facebook
Twitter
Instagram
You Tube
Tik Tok
Reddit
WhatsApp
LinkedIn
Other social media connections:
10.
In your family has anyone pursued education/job training in the last year for:
Adult Post Secondary Education
Job Training
Child Post Secondary Education
Please explain any education assistance you may have accessed:
11.
Have you needed any additional support navigating the school system?
Yes
No
If answer is yes, please explain:
12.
Have you utilized any faith-based support in the last year?
Yes
No
If you answered yes, please detail:
Almost finished! Your participation will help other Service Members, Veterans and their Families!
13.
For the above questions, were you able to find the resources you needed easily:
Was not able to find at all
1 star
Not easily
2 stars
Somewhat easily
3 stars
Easily
4 stars
Very Easily
5 stars
Comments:
14.
If you accessed any of the resources noted above, how quickly were you able to receive services you needed?
Unacceptable
1 star
Slowly
2 stars
Average
3 stars
Somewhat quickly
4 stars
Very Quickly
5 stars
Comments:
15.
What resources are you looking for that you have not been able to access:
16.
Have you experienced barriers in accessing services due to insurance issues?
Yes
No
Other (please specify)
17.
What resources have you or your family accessed that were helpful and would like to share:
18.
Any final comments:
19.
As a thank you, we would like to enter you into a drawing for a prize! Please enter your email address below; you will be notified by email if your name was drawn.
Email Address
20.
If you would like to stay involved in our work supporting our Service Members, Veterans and their Families, please check the box below:
Yes, I would like to stay involved!