PEQIS 19 Support Programs for Veterans and Active-Duty Service Members Pretest

Attachment 3: PEQIS 19 Questionnaire

U.S. DEPARTMENT OF EDUCATION NATIONAL CENTER FOR EDUCATION STATISTICS WASHINGTON, D.C. 20006-5651 SERVICES AND SUPPORT PROGRAMS FOR MILITARY SERVICE MEMBERS AND VETERANS, 2012–13 Postsecondary Education Quick Information System

FORM APPROVED O.M.B. No.: 1850–0733 EXPIRATION DATE: 05/2015 DRAFT 1-8-13

This survey is authorized by law (Education Sciences Reform Act of 2002, 20 U.S.C. 9543). While participation in this survey is voluntary, your cooperation is critical to make the results of this survey comprehensive, accurate, and timely. Your answers may be used only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose unless otherwise compelled by law (Education Sciences Reform Act of 2002, 20 U.S.C. 9573).

This survey should be completed by the person(s) most knowledgeable about services and programs for military service members and veterans at your institution.

IF ABOVE INSTITUTION INFORMATION IS INCORRECT, PLEASE UPDATE DIRECTLY ON LABEL.

Name of person completing this form: Telephone:

Title/position: E-mail:

Best days and times to reach you (in case of questions):

THANK YOU. PLEASE KEEP A COPY OF THIS SURVEY FOR YOUR RECORDS.

PLEASE RETURN COMPLETED FORM TO: IF YOU HAVE ANY QUESTIONS, CONTACT:

Mail: Barbara Queen Barbara Queen at Westat

Westat 800-937-8281 Ext. 4476 or 301-294-4476

1600 Research Boulevard E-mail: BarbaraQueen@westat.com
Rockville, MD 20850

Fax: 800-254-0984

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information is 1850–0733. The time required to complete this information collection is estimated to average 30 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collected. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202–4537. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: National Center for Education Statistics, 1990 K Street, N.W., Washington, D.C. 20006.

PEQIS Form No. 19, 04/2013

Please read the following instructions and definitions below before answering the questions.

For the purposes of this survey, the term military service members and veterans refers to active-duty service members, reservists, members of the National Guard, and veterans.

Please report about services and programs offered to all military service members and veterans enrolled for credit at your institution. Include those who receive military or veteran’s financial education benefits and those who do not receive financial education benefits but self-identify to the institution in another way.

Please include dependents of military service members and veterans who are receiving military or veteran’s financial education benefits in questions about enrollment and about services and programs involving these educational benefit programs.

Except where indicated, questions refer to the 12-month 2012–13 academic year. This includes the summer of 2012 or the summer of 2013, depending upon how records are kept at your institution.

1. Does your institution use any of the following ways to identify students who are military service members and veterans? (Indicate yes or no for each item.)

Yes No

a. Receipt of state or Federal military and veterans educational benefits

b. Questions on the admissions application

c. Student self-identification other than the admissions application (specify)

2. Does your institution have a dedicated social space for gathering (e.g., a student lounge) reserved specifically for military service members and veterans?

Yes No

3. Is there college/university owned or operated housing (on or off-campus) reserved specifically for military service members and veterans?

Yes No

4. Does your institution provide customized information to individual military service members and veterans about both the military and non-military financial education benefits available to them? (Only include individualized information beyond that provided to all students about financial aid benefits.)

Yes No

5. Does your institution have a staff member or office designated as the point of contact for military service members and veterans seeking information on the programs and services available to them? (Only include the Veterans Affairs (VA) certifying official if that person also provides information to military service members and veterans about programs and services available to them.)

Yes No

6. Are any sections of courses that are geared for the general student population reserved specifically for military service members and veterans? (Exclude noncredit courses.)

Yes No

7. Does your institution offer any courses that are designed specifically for military service members or veterans? (Exclude noncredit courses.)

Yes No

8. Does your institution award academic credit to students for military training received during active-duty service? (Include credit awarded on a case-by-case basis.)

Yes No

9. Does your institution customize your student orientation program for military service members and veterans? (Customization may include offering breakout sessions specifically for military service members and veterans during your student orientation program.)

Yes No

10. Does your institution provide admissions events or special information sessions customized for prospective students who are military service members or veterans?

Yes No

11. Are any of the following programs or organizations available at your institution for students who are military service members or veterans? (Indicate yes or no for each item.)

Yes No

a. Peer mentor program for military service members or veterans

b. Counseling/support groups for military service members or veterans

c. Student military or veteran organization

12. Does your institution have a formal mentoring or advising program in which faculty or staff members who are current or former members of the military mentor students who are military service members or veterans?

Yes No

13. Does your institution offer customized or additional support services specifically for military service members and veterans in the following areas? (Only report about additional or customized support services beyond those usually provided to students taking courses through your institution. Indicate yes or no for each item.)

Yes No

a. Academic support/tutoring

b. Academic advising

c. Study skills workshops

d. Assistance finding non work-study employment

e. Financial aid counseling

f. Career planning/services

g. Mental health counseling

h. Some other support service(s) (specify)

14. Does your institution provide information or referrals to students who are military service members or veterans regarding the following types of health-related off-campus services? (Indicate yes or no for each item.)

Yes No

a. Medical/health services

b. Counseling or mental health services

15. Please indicate in part 1 whether your institution offers training for faculty or staff in the following areas. For each area of training that your institution offers, please indicate in part 2 whether the training is mandatory for faculty or staff.

Area of training	Part 1. Institution offers training for faculty or staff?		Part 2. If offered, is training mandatory for faculty or staff?
a. Mental health issues associated with military service	Yes	No	Yes	No
b. Physical health issues resulting from military service	Yes	No	Yes	No
c. Student transition from military life to civilian life	Yes	No	Yes	No
d. Other training for faculty or staff on issues specific to military service members or veterans (specify)	Yes	No	Yes	No

16. How does your institution provide information to current or prospective students about the programs and services available to military service members and veterans at your institution? (Indicate yes or no for each item.)

Yes No

a. Mail

b. Email

c. Website

d. Social media

e. Brochures

f. Bulletin boards

g. College fairs

h. Military fairs

i. Other (specify)

17. In the last 12 months, has your institution assisted students in applying for VA tutorial benefits?

Yes No

18. Does your institution offer VA work-study opportunities?

Yes No

19. Do active-duty service members who are stationed in your state receive in-state tuition rates at your institution?

Yes No Not applicable

20. Which of the following describe your institution’s policy for charging veterans in-state tuition rates? (Indicate yes or no for each item.)

If in-state tuition does not apply to your institution, check here and skip to question 21.

Yes No

a. Veterans who previously resided in the state and were stationed elsewhere receive

in-state tuition rates immediately upon return to the state

b. Veterans who maintained the state as their home of record during active-duty service

receive in-state tuition rates

c. All veterans who currently reside in the state receive in-state tuition rates

d. Other policy (specify)

For Questions 21–24, please refer to the instructions and definitions at the beginning of the questionnaire.

21. During the fall of 2012, did your institution enroll any military service members, veterans, or dependents of military service members and veterans?

Yes No (Stop. Complete respondent section on front and return survey.)

22. During the fall of 2012, how many military service members and veterans, and dependents of military service members and veterans were enrolled in your institution? (For dependents, only include those who received military or veteran’s financial education benefits.)

	Military service members/veterans; and Dependents of military service members/veterans who received military or veteran’s financial education benefits
Number of undergraduate students
Number of graduate/professional students

23. Which of the following types of students are included in the enrollment counts reported at question 22? (Indicate yes or no for each item.)

Yes No

a. Active-duty service members, reservists, and members of the National Guard
who received military financial education benefits

b. Veterans who received veteran’s financial education benefits

c. Dependents of military service members and veterans who received military or veteran’s

financial education benefits

d. Military service members and veterans who self-identified as military service members

or veterans but did not receive military or veteran’s financial education benefits

24. How many of the students reported at question 22 are dependents of military service members or veterans who received military or veteran’s financial education benefits?

If your institution cannot report enrollments separately for dependents of military service members and veterans, check here and skip this question.

	Dependents of military service members/veterans who received military or veteran’s financial education benefits
Number of undergraduate students
Number of graduate/ professional students