EFMP Needs Survey

 

The Rock Island Arsenal ACS EFMP is continually striving to provide the best services to our military families.  The only way we can do that is to know exactly what you need.  Please complete the following form and return electronically by the “submit” button at the bottom or mail it to:

Department of the Army
AMSTA-RI-CF-ACS(EFMP)
1 Rock Island Arsenal
Rock Island, Il 61299-5000

  1.  I am :  - Single Parent        - Dual Active Duty         - Civilian        - Active Duty

2.  I live:  - On Post             - Off Post            How Long:

3.  Total number in household: 

4.  The service member is assigned to which unit? 

5.  Who is the special needs member (e.g., wife, husband, daughter, son?): 

6.  What is the special need of the family member: 

7.  If a child, what is the age? 

8.  Are you aware that the ACS office has an EFMP manager that has an understanding of resources
both military and in the community?  - Yes         - No

9.  Are you interested in the EFMP program manager contacting you?  - Yes          - No

10.  Are you interested in joining a support group?  - Yes         - No

11.  Please complete the following:

    a.  As a special needs military family, the biggest problem we have faced is:
   

    b.  Having a family member enrolled in EFMP adversely affects a soldiers career.
        - True          - False

    c.  My unit/sponsor's unit supports my special needs family.
         - True          - False

    d.  The schools here have been helpful with my EFMP child's problems
          - True          - False

12.  What do you consider to be the most important issues facing military EFMP families at the Arsenal?
(please number in order of importance)       

    Availability of medical care.     School transitions.
   Availability of child care.    Respite care availability.
    Continuity of care at new assignments.     Understanding my child's IEP.
    EFMP education of commanders.    Understanding the disability
    Priority placement in government quarters.      Other. -

13.  Other Comments:
   

14.  Name, address, and phone number (optional):
   

Form Complete?(Y)