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Center for Women Veterans Regional Summit Questionnaire
The VA is committed to serving our Women Veterans. Please assist the Center for Women Veterans (CWV) by answering the following questions.
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1.
Would you attend a Women Veterans Summit hosted in your region focused on VA services that you have earned and deserve?
(Required.)
Yes
No
If No, why not?
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2.
What is your name and current email address?
Please provide your first name, last name, and email address.
(Required.)
First Name
Last Name
Email Address
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3.
Where are you located?
Please provide City and State of your location.
(Required.)
City
State
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4.
Are you a Veteran / Have you served?
(Required.)
Yes
No
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5.
What wartime or peacetime era did/are you participate(ing) in? (Check all that apply)
(Required.)
World War II (December 7, 1941-December 31, 1946)
Post WWII (January 1, 1947-June 26, 1950)
Korean Conflict (June 27, 1950-January 31, 1955)
Post Korean (February 1, 1955-August 4, 1964)
Vietnam Era (February 28, 1961-May 7, 1975)
Post Vietnam (May 8, 1975-August 1, 1990)
Gulf War Era (August 2, 1990-Present/TBD)
OEI/OEF/OND (September 11, 2001-Present)
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6.
In which branch (or branches) of the United States military have you served? (Check all that apply)
(Required.)
Army
Marine Corps
Navy
Air Force
Coast Guard
Space Force
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7.
Are you currently on active duty status?
(Required.)
Yes
No
If Yes, please provide the name of the Base.
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8.
What benefits and services do you need assistance with? (Check all that apply)
(Required.)
Enrollment in Healthcare
Submitting a Disability Claim
End of Life Planning (Life Insurance, Memorial Benefits, Pre-Need Eligibility, etc.)
Community Care (Billing, Referrals, etc.)
Whole Health (Fitness, Diet, Meditation, Acupuncture, etc.)
Specialty Care (Podiatry, Physical Therapy, Gynecology, etc.)
Office of Small and Disadvantaged Business Utilization
Other (Please list other benefits and services that were not listed above.)