Orange County Survey for Ask The Questions Campaign
1.
Is your agency:
Aging & Senior Services
Children's Services & School Systems
Employment & Vocational Services
Faith-Based Groups
Health Care & Medical Services
Higher Education & Adult Learning
Housing & Homelessness Services
Law Enforcement & first Responders
Legal & Advocacy Services
Mental Health & Substance Abuse Services
Social Services- Federal/State/Local/Non-Profit
Women's Services & Crisis Centers
Domestic Violence and/or Sexual Assault
Other (please specify)
2.
Organization Name
3.
Estimated number of people you/your agency serve each year? (if it is not known. leave blank)
4.
Do you/your agency have a way of identifying clients as serving in the military, service members, veterans and/or military connected family members, including children? (Please check all boxes that apply)
I/We ask “Have you or a family member ever served in the military?”
I/We ask “Do you have children?”
I/We ask “Are you currently serving in the military?”
I/We ask “Is there anyone in your household serving in the military?”
I/We ask “Are you a veteran?”
I/We ask “ Is anyone in your household a veteran?”
I/We do not ask at all
I/We don’t know
Other – please specify below with what you ask. Details of what you ask/how you ask it:
5.
On a scale of 1-5, how familiar and comfortable are you/ your agency with identifying the needs of and corresponding resources for service members, veteran and veteran families?
1- NOT AT ALL familiar and comfortable
2- MINIMALLY familiar and comfortable
3- SOMEWHAT familiar and comfortable
4- FAMILIAR and COMFORTABLE
5- VERY FAMILIAR and COMFORTABLE
Other (please specify)
6.
On a scale of 1- 5 what is your agency's level of interaction / collaboration with other military and/or veteran-specific State, County and local resources?
1- NOT AT ALL connected
2- MINIMALLY connected
3- SOMEWHAT connected
4- CONNECTED
5- VERY CONNECTED
Other (please specify)
7.
Would you/your agency like to receive FREE military/ veteran family culture training?
Yes
No
8.
Would you/your agency like to receive FREE flyers targeted to service providers on how and why to ask the appropriate questions? Please indicate which:
Aging & Senior Services.
Children’s Services & School Systems.
Employment & Vocational Services.
Faith‐Based Groups.
Health Care & Medical Services.
Higher Education & Adult Learning.
Housing & Homelessness Services.
Law Enforcement & First Responders.
Legal & Advocacy Services.
Mental Health & Substance Use Disorders Services.
Social Services – Federal/State/Local/Non‐Profits.
Women’s Services & Crisis Centers.
Other (please specify)
9.
Would you/your agency like to receive more information and education regarding resources and referrals for veteran clients, military connected families, customers, patients or employers who answer "yes"?
Yes
No
10.
If you are interested in receiving training on any of the above topics, please indicate the topic, your organization and contact name and your email.
11.
Would you like to learn more about the Orange County Veteran and Military Families Collaborative (OCVMFC) which is a coalition of service organizations that facilitates access to comprehensive services for veterans, service members and their families?
Yes, please send me more information.
No, I am already a member.
No.
Other (please specify)
Current Progress,
0 of 11 answered