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Forward Community Needs Assessment
What is your current status?
Active Duty
Retiree
National Guard/Reservist
Department of the Army Civilian
*
What is your Rank/Pay Grade?
E-1
E-2
E-3
E-4
E-5
E-6
E-7
E-8
E-9
W-1
CW2
CW3
CW4
CW5
O-1
O-2
O-3
O-4
O-5
O-6
O-7
O-8
O-9
GS-01
GS-02
GS-03
GS-04
GS-05
GS-06
GS-07
GS-08
GS-09
GS-10
GS-11
GS-12
GS-13
GS-14
GS-15
NH-01
NH-02
NH-03
NH-04
NH-05
Retiree
*
What is your age range?
18-24
25-30
31-39
40-49
50-59
60+
*
What unit are you assigned to?
What is your current marital status?
Single
Married
Divorced
Widowed
*
How long have you been at your current duty station?
0-6 months
7-12 months
1-2 years
2-3 years
4+ years
*
Which of the following services do you CURRENTLY utilize? (Select all that apply & where you receive the service(s), i.e. SC, Atlanta GA, Fort Stewart...)
Childcare
Healthcare
Mental Healthcare
Military Family Life Counselor
Legal
Inspector General
Military Equal Opportunity
Equal Employment Opportunity
Soldier and Family Readiness Group
Chaplain
Morale Welfare and Recreation
Spouse employment resources
Educational opportunities
Are there any barriers that might prevent you from accessing these services (e.g., time, availability, scheduling)?
Is there anything else you would like to add about the services you need or want to see provided?
What is the single biggest challenge you face related to your well-being and quality of life?
Is education an issue for you and/or your family? (If yes, please select all that apply below):
No
Lack of affordable transportation to and from school
Children are not ready for school
Lack of affordable high-quality childcare
Lack of quality schools
Lack of post-secondary education (vocational skills/college education)
Lack of education resources in the community
Lack of certificate/degree programs offered locally
Other concerns (please specify)
How concerned are you about the school system for military children? (1-10 scale, where 1 is "Not at all concerned" and 10 is "Extremely concerned")
Is employment an issue for you and/or your family? (If yes, please select all that apply below):
No
Lack of jobs with better pay and benefits
Lack of job security
Lack of skills to obtain jobs
Lack of affordable transportation to and from work
Lack of affordable childcare during work hours
Lack of employment resources in the community
Other concerns (please specify):
Is healthcare or health an issue for you and/or your family? (If yes, please select all that apply below):
No
Lack of community focus on preventative healthcare
Lack of available medical providers
Lack of behavioral health providers
Lack of health resources in the community
Lack of nutrition education
Other concerns (please specify):
How concerned are you about your physical health? (1-10 scale, where 1 is "Not at all concerned" and 10 is "Extremely concerned").
How concerned are you about your mental health? (1-10 scale, where 1 is "Not at all concerned" and 10 is "Extremely concerned").
In the past year, have you had any thoughts about suicide?
Yes
No
In the past 6-12 months, have finances been an issue for you and/or your family?
Yes
No
Increased credit card debt
Rising cost of living
Increased cost of groceries / Healthy choices
Cost of childcare
Cost of housing
Loans
Other concerns (please specify):
In the past year, how many of the following stressors have you or your family experienced? (Select all that apply).
Financial difficulties
Legal difficulties
Relationship issues
School issues
Work challenges
Job security
Housing difficulties
Moving
Health issues
Death of a loved one
Crisis of faith
Despair
Which two of the following Chaplain Corps support opportunities offered in our community have been most impactful for you? (Select two only)
Prayer gatherings
Confidential counseling
Building Strong & Ready Teams Events
Bible study gatherings
Religious support of official functions
Other (Please specify):
What services can the Chaplain's Office provide or direct your spouse and family to in order to support spiritual growth?
Is there anything else you would like to share with us?
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