Veterans Needs Assessment Survey

The following questionnaire has been designed to identify the life challenges, needs and barriers that Veterans face within the county where you reside and is being presented to individual Veterans.

The answers provided will assist Wilson your county's Social Service in the creation of an updated community resource guide and in efforts to evaluate needed services for veterans.

The questions should take you no longer than 15 minutes to complete and the answers will not be linked to your name or organization for any purpose.

You are responding as a:

Not selected
Veteran
Family Member of a Veteran
Caregiver for a Veteran
Friend of a Veteran
Other

What is the gender of the Veteran?

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Male
Female
Prefer not to answer

What is the Veteran’s age group?

Not selected
18-27
28-44
45-59
60-84
85+

Is the Veteran

Not selected
Employed
Retired
Unemployed
Student
Other

Does the Veteran receive benefits through the Veterans Administration?

Not selected
Yes
No
Unknown

Does or has the Veteran received benefits/service through another Veteran’s assistance program?

Not selected
Yes
No

If you answered yes to the question above, please describe the benefits you received.

Has the Veteran ever received benefits or services through their county's Department of Social Services?

Not selected
Yes
No
Unknown

Please Explain.

Does the Veteran have health insurance?

Not selected
Yes
No

Has the Veteran ever been treated for a substance abuse problem?

Not selected
Yes
No
Unknown/ Prefer not to answer

If the Veteran has been treated for a substance abuse problem, please describe.

Does the Veteran have a permanent place to live?

Not selected
Yes
No

If the Veteran does not have a permanent place to live, please describe.

What benefits/services do you see as available to Veterans in your county?

What are other resources that are available to Veterans that are not listed above?

What benefits/services do you see as NOT available to Veterans in Wilson County?

Are there any other services that are NOT available to Veteran?

Does the Veteran have family or friends to support them?

Not selected
Yes
No

If you answered yes to question 18, does the family or friends live near the Veteran?

Not selected
Yes
No

Is the Veteran able to meet their financial obligations and living expenses?

Not selected
Yes
No

Please describe.

Does the Veteran have difficulty sustaining a good quality of life?

Not selected
Yes
No

If you answered yes to question 22, please explain.

What is the Veteran’s most urgent unmet need?

Does the Veteran have any other comments?

There are required fields in this form marked .