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Director Terry Prince

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Director Terry Prince

Department of Veterans Affairs
Programs
Women Veterans

WOMEN VETERANS PROGRAM

Women Veteran's Survey

This survey is to provide the Illinois Department of Veterans' Affairs with information about the issues and problems that the Women Veterans of Illinois face while serving or after serving their country. The data provided in this survey will help IDVA to better serve Illinois' Women Veteran population. If you are a Woman Veteran who has not visited a Veterans' Service Officer (VSO) to see what benefits or services are available to you, please visit "Stand Up and Be Counted" to be contacted by a VSO or please locate and contact your nearest VSO on our Veteran Service Officers tab.

* indicates required field

Title

How do you describe your military status?

Please select an item in the list.

What branch of service do/did you serve in?

Air Force

Army

Coast Guard

Marine Corps

National Guard/Reserves

Navy

Check all that apply

How long did you serve/have you served in the military?

Please select an item in the list.

What era did you serve in the military?

WWII Era (1941-1945)

Korea Era (1950-1953)

Vietnam Era (1964-1973)

Cold War Era (1985-1991)

Gulf War Era (pre 9/11; 1991-2001)

Gulf War Era (post 9/11; 2001 to present)

Any other era not listed above

Check all that apply

What is your current rank or your rank upon separation?

Please select an item in the list.

What was your occupational specialty/job classification upon separation?

If not implied, please give brief description.

Are you a combat veteran or have you ever been deployed?

Please select an item in the list.

Do you self-identify as a Veteran?

Please select an item in the list.

Please enter your email address in the space provided if you are interested in receiving Women Veteran related info:

What city do you reside in?

What county do you reside in?

What is your age?

Please select an item in the list.

What is your marital status?

Please select an item in the list.

Have you ever had a veteran spouse/partner?

Please select an item in the list.

How many children under 18 do you have living at home?

Please select an item in the list.

What is your highest level of education?

Please select an item in the list.

Have you used Federal or State VA educational benefits?

Please select an item in the list.

How do you describe where you live?

Please select an item in the list.

When you separated, was your Home of Record in Illinois?

Please select an item in the list.

Did you give permission for your discharge papers (DD 214) to be sent to your Home State?

Please select an item in the list.

How often do you interact with IDVA?

Please select an item in the list.

The State of Illinois provides a variety of services and benefits for Veterans. For the following State of Illinois Veterans Benefits, please mark all or any that you have used.

WWII Bonus

Korean Bonus

Vietnam Bonus

Vietnam Survivors' Compensation

Persian Gulf Bonus

GWOT (OEF/OIF) Conflict Bonus

GWOT Survivors' Compensation

POW Compensation

Burial Assistance

Educational Benefits

Real Estate Benefits

Camping and Admission Fees

Hunting and Fishing Privileges

Illinois Warrior Assistance Program

Veterans Care

None of the above

Please mark all that apply.

If you have not used any of the services/benefits listed above, which of the following best describes why?

I am not eligible for services/benefits

I am not sure if I am eligible

I was unaware of the services available

I do not know how to apply

The application process is too complicated or confusing

My local VSO is too far away

N/A

Please select all that apply.

Have you used community veteran service organizations for assistance/resources?

Such as American Legion, VFW, AMVETS, etc.

Are you currently employed?

Please select an item in the list.

Have you used veteran services and resources available through the Illinois Department of Employment Security (IDES)?

Please select an item in the list.

Since your separation, have you had any problems with housing?

Please select an item in the list.

Given your means of transportation, what would you consider the closest Federal VA medical facility to be?

Please select an item in the list.

How far do you live from the closest Federal VA medical facility or community based outpatient clinic?

Please select an item in the list.

Which of the following best describes your health care insurance status?

Please select an item in the list.

Please rate your current general health status:

Please select an item in the list.

For the following list of medical conditions, please check which ones currently impact your health status:

Amputations

Head Injuries

Musculoskeletal Disorders

Adjusting to physical limitations

Cardiac Issues

Diabetes

Lung Problems

Urological Problems

Gynecological Problems

Sleep Disorders

Anxiety

Depression

Sexual Assault/Military Sexual Trauma

Post Traumatic Stress Disorder (PTSD)

Stressors of single parenting

Guilt for leaving family for deployment

Substance abuse

Other

N/A

Are any of the above Medical Conditions Service Related?

Please select an item in the list.

Do you currently have a disability rating from the VA?

Please select an item in the list.

What disability rating have you received from the VA?

Please fill out this field.

If you have ever used the services of the federal Veterans Administration (VA) hospitals or clinics, please rate (in general) your experience of the services you received.

Please select an item in the list.

If you have NEVER sought medical services at a federal VA facility, or are no longer seeking medical services, which of the following statements best describes why not?

Not eligible for service

Not sure if eligible for service

Facility is too far from residence

Lack of transportation

Appointment/scheduling delays

Poor service or quality of care

Lack of childcare

Prefer to use non-VA facility

Have no need to seek services through Federal VA

N/A

Please select all that apply.

Have you ever been treated or are you currently being treated for any mental health disorders such as Post Traumatic Stress Disorder (PTSD) or Traumatic Brain Injury (TBI)?

Please select an item in the list.

If you sought treatment for mental health, do you feel you received the services you needed?

Please select an item in the list.

Have you ever been treated for or are you currently being treated for alcohol or substance abuse?

Please select an item in the list.

If you sought treatment for alcohol or substance abuse, do you feel you received the services you needed?

Please select an item in the list.

What challenges have you had making the transition from Active Duty?

What information or services do you wish you had available to you when you separated/transitioned from Active Duty?

What services do you need? What services or benefits should be provided to address the needs of women veterans?

Are you interested in learning more about starting your own business, with help from experts on business ownership and veteran resources?

Date

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