This free survey is powered by
QUESTIONPRO.COM
Create a Survey
Surveys
2012
February
A
Armed Forces Retirement Home Questionnaire
Armed Forces Retirement Home Questionnaire
0%
Exit Survey »
Age
Gender
Male
Female
Race/Ethnicity
Caucasian/White
African American
Hispanic
Asian/Pacific Islander
Other
Highest level of Civilian Education?
Some High School
GED
High School Diploma
Some College
Associate's Degree
Bachelor's Degree
Master's Degree
Doctorate Degree
Grade/Rank
E1 – E4
E5 – E6
E7 - E9
O1 – O3
O4 – O9
WO1 – WO5
How many years did you serve in the military?
What is your current marital status?
Single, never married
Married, living with spouse
Married, but separated
Married, geographically separated
Divorced
Widowed
How many times did you deploy for more than 30 days to any of the following? MARK ALL THAT APPLY
Never
One Time
Two Times
Three or more Times
WWII
Korea
Vietnam
Iraq (OIF)
Kuwait or Qatar (OIF)
Afghanistan (OEF)
Bosnia/Kosovo (Peacekeeping)
Other_____________________
How often did you experience the following during your military service?
Never
One Time
Two to Four Times
Five to Nine Times
Ten or More Times
Being attacked or ambushed
Receiving small arms fire
Seeing dead bodies or human remains
Handling or uncovering human remains
Seeing dead or seriously injured Americans
Knowing someone seriously injured or killed
Participating in demining operations
Shooting or directing fire at the enemy
Engaging in hand-to-hand combat
Clearing/searching homes or buildings
Never
One Time
Two to Four Times
Five to Nine Times
Ten or More Times
Being wounded/injured
Seeing ill/injured women or children who you were unable to help
Receiving incoming artillery, rocket, or mortar fire
Being directly responsible for the death of a non-combatant
Had a close call, was shot or hit but protective gear saved you
Had a buddy shot or hit who was near you
Save the life of a Soldier or civilian
Improvised explosive device (IED)/booby trap exploded near you
Loading...
close
Loading...
Close
qpweb2.questionpro.net
Loading...
