Veteran's Community Reintegration Focus Groups

OMB No. 0704-TBD
OMB approval expires:
For Official Use Only:

TAP/Transition GPS Focus Group Intake Form
The information collected on this form will be used to compare the focus group sample of servicemembers to the entire population of servicemembers. Completing this form is voluntary.
If there are any questions you do not wish to answer, you may leave them blank. This form
should take no more than 10 minutes to complete
1. What was your age upon separation?
2. What is your gender?
 Female
 Male
3. Are you Spanish/Hispanic/Latino?
 No, not Spanish/Hispanic/Latino
 Yes, Mexican, Mexican-American, Chicano, Puerto Rican, Cuban or other Spanish/Hispanic/Latino
4. What is your race? Mark one or more races to indicate what you consider yourself
to be.






White
Black or African American
American Indian or Alaska Native
Asian (e.g., Asian Indian, Chinese, Filipino, Japanese, Korean, or Vietnamese)
Native Hawaiian or other Pacific Islander (e.g., Samoan, Guamanian, or Chamorro)

5. What was the highest degree or level of schooling that you had completed
at the time of separation? Mark the one answer that describes the highest grade or
degree that you had completed upon separation.









12 years or less of school (no diploma)
High school graduate–traditional diploma
High school graduate–alternative diploma (GED, home school, etc.)
Some college credit, but less than 1 year
1 or more years of college, no degree
Associate’s degree (e.g., AA, AS)
Bachelor’s degree (e.g., BA, AB, BS)
Master’s, doctoral, or professional degree (e.g., MA, MS, Med, MEng, MBA,
MSW, PhD, MD, JD, DVM, EdD)
1

6. What was your marital status at the time of separation?
 Married
 Separated

 Divorced
 Widowed

 Never Married

7. Did you have children or other legal dependents (excluding your spouse) at
the time of separation?
 Yes

 No

8. With which service are/were you affiliated?
 Army

 Navy

 Marine Corps

 Air Force

9. What was your pay grade upon separation?
 E1-E3
 E4-E6
 E7-E9

 W1-W5

 O1-O3
 O4-O6

10. How many months has it been since you were on active duty?

11. How many months were you deployed away from your home station during
your time on active duty?

12. How many of the months that you were deployed involved deployment
within a combat zone?

13. If you have transitioned off active duty, were you serving in the regular or
reserve component prior to separation?
 Regular

 Reserve

 Not applicable

14. If you are currently in the transition process, are you transitioning from
the regular or reserve component?
 Regular

 Reserve

 Not applicable

2