Women Veterans Benefits Survey

TVC's Women Veterans Collaborative wants to ensure women veterans are informed about potential medical and general benefits that are available as a result of military service.

If you were ever hurt or injured while on active duty or active duty for training, and you are still having problems, you may be eligible to file for a service-connected disability.

If you already receive service-connected disability compensation, there are other benefits that may be available to you based on your disability rating.

Please take a moment to answer the following questions.

All responses are confidential in nature and participation is voluntary. Aggregated results and feedback is shared with appropriate staff members.

Please provide the following information to better determine what benefits may be available to you:

Question Title

* 1. Contact Information:

Name:

Phone/Email:

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* 2. Branch of service (Check all that apply):

Army

Air Force

Navy

Marine Corps

Coast Guard

Reserves

National Guard

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* 3. Type of discharge:

Honorable

General

Other than Honorable (OTH)

Dishonorable

Bad Conduct

Other

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* 4. Time in Service:

Date of initial enlistment (mm/dd/yyyy):

Date of final separation (mm/dd/yyyy):

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* 5. Where do you currently live?

City:

State:

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* 6. Are you currently homeless, at risk of being homeless, temporarily living with a friend/family, or living in an unsafe environment?

Yes

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* 7. Have you ever filed a claim for service-connected disability/disabilities?

Yes