This survey is being conducted by the Americorps CADCA Vetcorps Project and Healthy Androscoggin. The purpose of this survey is to conduct a needs assessment of resources and services for Substance Abuse, Mental Health Issues, Homelessness and Joblessness for Veterans, Service Members, and Military Family Members (VFM) in Androscoggin County. If you have any questions about this survey or if you need further information related to services, contact Alley Smith (VISTA CADCA VetCorps Prevention Coordinator) at smithal1@cmhc.org or (207) 795-2545

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* 1. Which one of these options applies to you?

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* 2. What town do you live in?

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* 3. Years in Military Service and branch:

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* 4. Gender:

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* 5. Race:

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* 6. Number of dependents?

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* 7. Age:

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* 8. Education: Check highest grade completed.

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* 9. What services are you currently or have you previously needed assistance with?

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* 10. Are or were you aware of all the services listed above in question #10?

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* 11. What behavioral/mental health services do you believe need to be expanded for veterans? (mark all that apply)

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* 12. What are some of the best resources available for VFM in Androscoggin County?

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