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pdfLongitudinal Study Survey
Department of Veterans Affairs, Education Service Division is conducting a Longitudinal
Study of Veterans participating 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 this yearly survey. Your feedback is very
important to us. Data reported to outside sources will be reported in aggregate form
and not be specific to you. 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 enclosed pre-addressed postage-paid envelope.
Current Status
0a. How have you used the Post-9/11 GI Bill benefits so far? (Check all that
apply.)
Took college or university coursework leading to a degree
Took college or university coursework not leading to a degree
Attended business, technical or vocational school training leading to a certificate
or diploma
Participated in an apprenticeship or on-the-job training program
Took correspondence courses
Took flight training
Received tutorial assistance, refresher courses, or deficiency training
Attended a teacher certification program
Other: ____________________________________
1. Are you currently using your Post-9/11 GI Bill benefits, or using Post-9/11 GI
Bill benefits that were transferred to you? (Check only one.)
Yes
(Skip to item 3)
No
1a. Why are you no longer using the Post-9/11 GI Bill benefits? (Check only one.)
Successfully completed classes or training
(Skip to item 3)
Used all eligible months available
(Skip to item 3)
Suspended by school
(Skip to item 3)
Voluntarily withdrew or stopped attending classes or training
Other: ____________________________________
2. Why did you voluntarily withdraw or stop attending classes or training?
(Check all that apply.)
Medical reasons
Financial reasons
Family responsibilities
Found a job prior to program completion
Successfully met my educational or training goals
Transportation difficulties
Training or educational program did not meet my needs
Training or educational program requirements were too difficult
Lost interest in training or educational program
To pursue another education benefit (Ch31, State Voc Rehab, etc)
Other: ____________________________________
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Benefits
3. At any time in the past 12 months, did you receive any of the following benefits
from Social Security? (Check all that apply.)
Did not receive SS benefits
Supplemental Security Income (SSI)
Social Security Disability Insurance (SSDI)
Medicare
Retirement
Survivor’s or Dependent
Other: ____________________________________
Employment
4. During the last week, were you…
(Check only one.)
Working, or on paid vacation or sick leave from work?
(Skip to item 5)
Not working, but looking for work?
(Skip to item 5)
Not working and not looking for work?
4a. What is the main reason you were not looking for work? (Check only one.)
Going to school
Ill, or disabled and unable to work
Retired
Taking care of home or family
Could not find work
Other: ____________________________________
5. Were you employed at any time in the past 12 months? (Check only one.)
Yes
No
(Skip to item 9)
6. During the past 12 months (52 weeks), how many weeks were you employed?
(Fill in number of weeks.)
Weeks employed: ____________
7. During the past 12 months, in the weeks you worked, how many hours did you
usually work each week? (Fill in number of hours.)
Hours per week: ____________
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8. During the past 12 months, how much did you earn from all jobs or businesses
before taxes and other deductions? (Check only one and fill in the number.)
Yearly salary ___________
Hourly rate ____________
9. During the past 12 months, did you receive any counseling, training, job
search assistance, or other assistance to help you find or keep a job?
Yes
No
(Skip to item 10)
9a. How much did this assistance contribute to your success in finding or
keeping a job?
A lot
Some
A little
None
10. What was your gross income during the past 12 months, from each of the
following sources?
a. Wages, salary, commissions, bonuses,
or tips from all jobs .............................................. $___________
b. Interest, dividends, net rental income, royalty,
Income, or income from estates and trusts ....... $___________
c. Social Security or Railroad Retirement .............. $___________
d. Supplemental Security Income (SSI) .................. $___________
e. Any public assistance or welfare payments
from the state or local welfare office .................. $___________
f. Retirement, survivor, or disability pension
(NOT including Social Security) .......................... $___________
g. Any other sources of income received regularly
such as Veterans’ (VA) payments, unemployment
compensation, child support, or alimony .......... $___________
TOTAL INCOME (add a – g) ...................................... $___________
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11. At any time in the past 12 months, did you receive unemployment
compensation?
Yes
No
(Skip to item 12)
11a. How many weeks of unemployment did you receive? (Fill in number of
weeks.)
Number of weeks: ____________
Education
12. At any time in the past 12 months, were you enrolled in an Institution of Higher
Learning (IHL)? (An Institution of Higher Learning is defined as a college,
university, or similar institution 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
(Skip to item 16)
12a. What was the major subject or field of study of the education or training
program in which you were enrolled?
______________________________________________________
13. Were you in school part-time, full-time, or both during the past 12 months?
(Check only one.)
Part-time
Full-time
Both part-time and full-time
14. During the past 12 months, how many academic credit hours did you
complete? (Check only one.)
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
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15. How did you pay for this education or training? (Check all that apply.)
VR&E VetSuccess Program (Chapter 31)
Veterans Educational Assistance Program (Chapter 32)
GI Bill (Chapter 30 or Chapter 33)
Reserve Educational Assistance (Chapter 1607)
Military Tuition Assistance
Pell Grant
Federal Loan (e.g., Stafford Loan)
Grants or scholarships from the state or my institution
Loan or line of credit from my institution
Private student loan (non-federal bank loans)
Loan from family or friends
Personal funds (e.g., income from a job or savings)
Other: ___________
16. During the past 12 months, did you receive any of the following degrees?
(Check all that apply.)
Did not receive a degree in the past 12 months
Regular high school diploma
GED
Associate’s degree (e.g., AA, AS)
Bachelor’s degree (e.g., BA, BS)
Master’s (e.g., MA, MS, MEng, MEd, MSW, MBA)
Doctorate degree (e.g., PhD, EdD)
Other Professional degree (e.g., MD, JD, PharmD): ________________
17. During the past 12 months, did you receive a certificate, diploma, or license
from a business, technical, or vocational school?
Yes
No
(Skip to item 18)
18. List the certificates, diplomas, or licenses you received from a business,
technical, or vocational school during the past 12 months (e.g., CDL license,
HVAC Certification, etc.).
_________________________
_________________________
_________________________
_________________________
_________________________
_________________________
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19. Were you enrolled in any other education or training programs during the past
12 months? (Check all that apply.)
Was not enrolled in any other education or training programs in the past 12
months
Non-College degree program (NCD)
On-the-job training (OJT)
Volunteer work experience
Non-paid work experience (NPWE)
Apprenticeship
Special Employer Incentive (SEI)
Compensated Work Therapy (CWT)
Other: ____________________________________
19a. What was the major subject or field of study of the education or training
programs in which you were enrolled?
______________________________________________________
______________________________________________________
______________________________________________________
Medical
20. During the past 12 months, how many times did you go to a VA Medical
facility for each of the following reasons? (Fill in each one with a number. Put
zero if you did not go to a VA Medical facility for that reason.)
a. Emergency visits: __________
b. Routinely scheduled visits (checkups, screenings, etc.): ____________
c. Treatment visits (PT, OT, counseling, etc.): ______________
21. During the past 12 months, how many times did you go to a non-VA medical
facility for each of the following reasons? (Fill in each one with a number. Put
zero if you did not go to a non-VA Medical facility for that reason.)
a. Emergency visits ___________
b. Routinely scheduled visits (checkups, screenings, etc.) _____________
c. Treatment visits (PT, OT, counseling, etc.) ________________
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Household
22. 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).
$__________
23. Do you own your principal residence? (Your principal residence is the home
where you live for at least half of the year.)
Yes
No
24. How many dependents do you currently have? (Dependents include a spouse,
children under 18, children between the ages of 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).
Spouse:
Children under 18:
Children 18-23 years old attending school:
Children who are permanently incapable of selfsupport because of disabilities arising before age 18:
Dependent parents:
__________
__________
__________
__________
__________
Overall Experience
25. Thinking about ALL aspects of your experiences and outcomes during the
past 12 months 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.) If you did not attend an educational
institution during the past 12 months, check that box.
Did not attend an educational institution in the past 12 months
1
Unacceptable
2
3
4
5
Average
8
6
7
8
9
Outstanding
26. What is the primary reason you applied for the Post-9/11 GI Bill program?
(Check only one.)
Further my education for self-improvement
Further my education so I could become employed or qualify for a higher
paying job
Further my education so I could keep my current job
Further my education to start my own business
Other (Specify): _____________________
27. 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
Not currently working
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
Neither Agree or Disagree, and 9 is Strongly Agree. (Mark only one.)
The Post-9/11 GI Bill program assisted in my ability to develop the skills that I
need to get a job.
1
Strongly
Disagree
2
3
4
5
Neither
Agree or
Disagree
9
6
7
8
9
Strongly
Agree
File Type | application/pdf |
File Title | Longitudinal Study Survey |
Author | VREPSALA |
File Modified | 2013-04-26 |
File Created | 2013-04-26 |