Longitudinal Study Survey
The Department of Veterans Affairs, Education Service, is conducting a Longitudinal Study of Veterans who have participated in the Post-9/11 GI Bill (Chapter 33). This study will take place over the next 20 years.
You have been randomly selected to participate in this study. We are requesting that you complete a survey each year, for the next 20 years. Information gathered will be used to help understand the long-term benefits of the Chapter 33 program and help us improve services for other Veterans.
Please take a few moments to complete the first survey attached. Your feedback is very important to us. Your responses will also be kept private to the extent of the law and will not be used for any purposes other than for this study.
If you have any questions about the survey, please call 1-800-XXX-XXXX or email info@xxxxxxxx.com. Your participation is very much appreciated.
Please mail the survey in the envelope provided to:
DEPARTMENT OF VETERANS AFFAIRS
Education Division (223B)
1800 G Street, NW
Washington, DC 20006
1. Are you currently participating in the Post-9/11 GI Bill program? (Check only one)
Yes
No
1a. If you answered No to Question #1, why are you no longer participating in the program? (Check only one)
Successfully completed the program
Used all eligible months available
Suspended by school for unsatisfactory attendance, progress or conduct
2. If you withdrew from the program, what was your reason? (Check all that apply)
Medical problems
Financial problems
Family responsibilities
Found a job prior to program completion
Transportation difficulties
Program did not meet my needs
Program requirements were too difficult
Lost interest
To pursue another education benefit (Ch31, State Voc Rehab, etc)
Other: ____________________________________
3. During the past 12 months, did you receive any of the following benefits from Social Security? (Check all that apply)
Supplemental Security Income (SSI)
Social Security Disability Insurance (SSDI)
Medicare
Retirement
Survivor’s or Dependent
Other: ____________________________________
Did not receive SS benefits
Employment
4. Are you currently working at a job or business? (Check only one)
Yes
No
4a. If you answered No to Question #4, what is the main reason you are not currently working? (Check only one)
Ill, or disabled and unable to work
Retired
Taking care of home or family
Going to school
Could not find work
Doing something else
Other: ____________________________________
5. During the past 12 months, how many months were you employed? (Check one and please fill in # of months)
Months employed: ____________
Was not employed at any time during the past 12 months
5a. During the past 12 months, how many hours per week did you usually work at your main job? (Check one and please fill in # of months)
Hours per week: ____________
Was not employed at any time during the past 12 months
6. During the past 12 months, how much did you earn from all jobs or businesses before taxes and other deductions?
Yearly salary ___________
Hourly rate ____________
Was not employed at any time during the past 12 months
7. If you were employed during the past 12 months, how much did counseling, training, job search assistance, or other assistance contribute to your success?
A lot
Some
A little
None
Was not employed at any time during the past 12 months
8. What was your gross income during the past 12 months? (Your gross income includes income you received from all sources, before taxes, including earnings from a job, benefits received from government programs, and any retirement, pension, investing, or savings income that you receive regular payments from.)
$___________
9. During the past 12 months, did you receive unemployment compensation?
Yes
No
10. If you answered Yes to Question #9, how many weeks of unemployment did you receive?
Number of weeks _________
11. During the past 12 months, have you been enrolled in an Institution of Higher Learning (IHL)? (An institute of higher learning is defined as a college, university, or similar institution, including a technical or business school, offering postsecondary level academic instruction that leads to an associate or higher degree if the school is empowered by the appropriate State education authority under State law to grant an associate or higher degree).
Yes
No
12. If you answered Yes to Question #11, were you in school part-time, full-time, or both?
Part-time
Full-time
Both part-time and full-time
13. Did you receive any of the following degree levels during the past 12 months? (Please check all that apply)
High school diploma or GED
Certificate
Associates
Bachelors
Masters
PhD
Other Professional Degree (e.g., MD, JD, PharmD): ________________
Did not complete a degree this year
14. How many academic credit hours did you complete during the past 12 months?
1 to 10
11 to 20
21 to 30
31 to 40
41 or more
Credits were not recorded
Did not complete any credits this year
15. How did you pay for this training? (Please check all that apply)
VR&E VetSuccess Program (Chapter 31)
GI Bill (Chapter 30 or Chapter 33)
Financial Aid/Pell Grant
Personal Loan
Personal funds
Other: ___________
16. Did you receive any professional or trade certificates or licenses during the past 12 months?
Yes
No
17. If you answered Yes to Question #16, how many certificates or licenses did you receive and what type of certificate(s) or license was it? (e.g., CDL license, HVAC Certification, etc.)
1. Number of Certificate(s) or License(s): ________
2. Type of Certificate(s) or License(s): _______________
18. Were you enrolled in any other education or training programs during the past 12 months? (Please check all that apply)
Non-College degree program (NCD)
On-the-job training (OJT)
Volunteer
Non-paid work experience (NPWE)
Apprenticeship
Special Employer Incentive (SEI)
Compensated Work Therapy (CWT)
Other: ____________________________________
19. During the past 12 months, how many visits have you made to a VA Medical facility? (Please fill-in each one with a number. Put zero if you did not make a visit)
Emergency visits: __________
Routine and scheduled visits (checkups, screenings, etc): ____________
Treatment visits (PT, OT, Psychology, etc): ______________
20. During the past 12 months, how many visits have you made to a Non-VA medical facility? (Please fill-in each one with a number. Put zero if you did not make a visit)
Emergency visits ___________
Routine and scheduled visits (checkups, screenings, etc) _____________
Treatment visits (PT, OT, Psychology, etc) ________________
21. During the past 12 months, what was your gross household income? (Your household income is the combined before-tax income of people who share their income and live in the same home. Typically, this would be you and your spouse).
$__________
22. Do you own your principal residence? (Your principal residence is the home where you live for at least half of the year).
Yes
No
23. How many dependents do you currently have? (Dependents include spouses, children under 18, children between ages 18 and 23 who are attending school, children who are permanently incapable of self-support because of disabilities arising before age 18, and dependent parents). Please specify what kind of dependent you have (spouse, child under 18, etc).
# of dependents _______________
Type of dependent(s) __________________
24. Thinking about ALL aspects of your experiences and outcomes with your most recently attended educational institution, please rate it overall, using 1 to 9 scale where 1 is Unacceptable, 5 is Average, and 9 is Outstanding. (Mark only one)
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
Unacceptable |
|
|
|
Average |
|
|
|
Outstanding |
25. What is the primary reason you applied for the Post-9/11 GI Bill program? (Check only one)
Get any job
Get a better job
Further my education so I could become employed or qualify for a higher paying job
Get a job that accommodated my disability
Start my own business
Get help to keep my current job
Improve my job-seeking skills so I could become employed
Career Counseling so I could best use my benefits to enter the right career
Independent Living Services
Other (Specify): _____________________
26. If you are working, does your current job generally match the training you received while you participated in the Post-9/11 GI Bill program?
Yes
No
Somewhat
27. Thinking about your experience with the Post-9/11 GI Bill program, please rate the following statement, using a 1 to 9 scale where 1 is Strongly Disagree, 5 is Agree, and 9 is Strongly Agree. (Mark only one)
The Post-9/11 GI Bill program assisted in my ability to become employable?
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
Strongly Disagree |
|
|
|
Agree |
|
|
|
Strongly Agree |
28. Thinking about your experience with the Post-9/11 GI Bill program, please rate the following statement, using a 1 to 9 scale where 1 is Strongly Disagree, 5 is Agree, and 9 is Strongly Agree. (Mark only one)
The Post-9/11 GI Bill program assisted in my ability to live more independently.
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
Strongly Disagree |
|
|
|
Agree |
|
|
|
Strongly Agree |
29. In the future, what is your preferred method for being contacted?
Yes No…………………………Email/Web
Yes No…………………………Telephone
Yes No…………………………Mail
File Type | application/msword |
File Title | Longitudinal Study Survey |
Author | VREPSALA |
Last Modified By | EDUEJONE |
File Modified | 2012-06-28 |
File Created | 2012-06-28 |