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.

Question Title

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

Question Title

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

Question Title

* 3. Age

Question Title

* 4. Gender (check one)

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

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

T