Veteran Public Servant Survey

Thank you for visiting the Montgomery County Civil Service Veteran Survey. We are launching this survey to learn more about veterans in Montgomery County, better tailor our outreach, launch initiatives to better serve the veteran community, and gather information about challenges in order to start programs and maximize the number of claims we administer.

Your employer sent this to you but they have no way of seeing the results

This survey is in two parts and any health info is separate from your Personally Identifiable Information

This survey is voluntary but highly encouraged

You can fill out this survey for a veteran

Question Title

* 1. Contact Information

Name

Public Service Employer/Department

Address

Date of Birth

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. Veteran Service Dates

Question Title

* 3. Veteran's Branch

Question Title

* 4. Active or Reserves?

Active

Reserves

Question Title

* 5. Service Number (Optional)

Question Title

* 6. Did the veteran ever deploy (this does not include 2 weeks active duty for training)

Yes

If yes, include location.

Question Title

* 7. Veteran Military Rank/Paygrade

Question Title

* 8. Do you have minor children in your home (children or grandchildren)?

Yes

If yes, are you interested in free school supplies and/or help during the holidays?

Question Title

* 9. Person completing this survey if not the veteran

Name

Email Address

Question Title

* 10. Are you a veteran or surviving spouse?

Veteran

Surviving Spouse