Thank you for your willingness to complete this survey. Your responses to this survey will be kept confidential and your responses will only be reported summarized with other responses. This is NOT a test. There are no right or wrong answers to the questions, so please choose the responses that best apply to you.

* 1. What is the name of your Program or Corps?

* 2. Program/Corps Location (City, State)

* 3. Age

* 4. Gender (check one)

* 5. Are you a parent or primary caregiver of a child?

* 6. Are you a primary caregiver of a parent or other adult (e.g., disabled or sick relative)? 

* 7. Have you served on active duty in the military?

* 8. How do you identify yourself in terms of ethnicity/race? Please select all that apply:

* 9. Where do you currently live?(City or town, State)