JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
East Buffalo Veterans Study
Please help us learn more about the needs of Veterans in East Buffalo
by taking 5-10 minutes to answer a few questions. Thank you!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Are you a Veteran?
*
Yes
No
How old are you?
*
18-29
30-45
46-60
60+
Do you live in East Buffalo?
*
Yes
No
What is your race / ethnicity? (optional)
African American
Asian
Hispanic / Latino
Native American
Caucasian
Multi-racial
Alaskan Native / Pacific Islander
Other
Clear selection
If you are a Veteran, where do you go to find services locally?
Your answer
Based on what you know, what is the highest need for Veterans living in East Buffalo?
*
Your answer
Is there anything else that might help us understand the needs of Veterans living in East Buffalo?
*
Your answer
Please rate, from 1-5, the services most needed in East Buffalo:
*
1 (No Need)
2 (Low Need)
3 (Some Need)
4 (Moderate Need)
5 (Highest Need)
Housing
Health Care
Transportation
Counseling / Mental Health
Employment
Education
1 (No Need)
2 (Low Need)
3 (Some Need)
4 (Moderate Need)
5 (Highest Need)
Housing
Health Care
Transportation
Counseling / Mental Health
Employment
Education
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Olmsted Center for Sight.
Report Abuse
Forms
