First Name
Last Name
Pronoun
Email
With which of the following do you identify? Please select all that apply: Please specify
With which of the following do you identify as a Veteran Family member? Check all that apply: During your military service, where do or did you serve? Check all that apply. Please specify
For how long have you served with the Canadian Armed Forces Regular Force?
For how long have you served with the Canadian Armed Forces Reserve Class A?
For how long have you served with the Canadian Armed Forces Reserve Class B or C?
During your military service, which element do or did you serve in? Check all that apply. During your service as a member of the RCMP, which option describes your type of employment? Check all that apply. For how long have you served with the Royal Canadian Mounted Police (Full Time)?
For how long have you served with the Royal Canadian Mounted Police (Auxiliary)?
Are you a VAC-approved provider? Please indicate your organizational affiliation*:
Title / position
How did you hear about this event? Please specify
What do you hope to learn by attending the Family Summit?
Submit a question
The Atlas Institute is committed to providing an accessible environment in which all individuals have access to our events. Please specify what supports would help you to participate in our event and we will do our very best to accommodate them.
Is this your first time attending the Veteran Family Summit? Please select Yes No
Which previous event(s) did you attend? Check all that apply. What drew you to attend the Veteran Family Summit again this year?
Has the information from previous Veteran Family Summits improved your ability to support yourself? Please select Yes No
Has the information from previous Veteran Family Summits improved your ability to support your loved one? Please select Yes No
Have you experienced personal benefits or changes as a result of attending the Veteran Family Summit? Please select Yes No
Please elaborate:
Has attending the Veteran Family Summit improved your understanding of Veteran Family mental health and well-being? Please select Yes No
Please elaborate:
Has attending the Veteran Family Summit directly led to improvements in your service delivery or patient/client care? Please select Yes No
Please elaborate:
Have you recommended the Veteran Family Summit to anyone? Please select Yes No
Why did you recommend the Veteran Family Summit?
What would inspire you to recommend the Veteran Family Summit to others?
Can the Atlas Institute potentially feature your comment as an anonymous quote in future promotional materials for the Veteran Family Summit? Please select Yes, I give permission No, I do not give permission
PART TWO: DEMOGRAPHIC INFORMATION
The following are optional demographic questions. You can answer all, some, or none. The purpose of asking these questions is to better understand who is attending our events, so that we can reach an equitable representation of military and RCMP Veterans and their Families, and to tailor our offerings to better serve our audiences and stakeholders. Aggregated survey results may also be shared with Veterans Affairs Canada as part of our reporting requirements however, your individual responses to these questions are completely confidential. The survey should take approximately 5 to 10 minutes to complete.
If you would like to share demographic details about yourself, choose “Continue”. If you are ready to complete your registration, choose “No” and submit the form. Your participation is greatly appreciated! Please select Continue No
In which province/territory are you located? Please select Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Québec Saskatchewan Yukon Outside of Canada Prefer not to say
In what type of community do you live most of the time*? Please select Urban Suburban Rural Remote Other (Please specify) Prefer not to say Other
Please specify
Do you prefer to access knowledge resources in English or French? With which ethnic or racial origins do you identify? Please select all that apply. Please specify
With which gender(s) do you identify? Please select all that apply. Please specify
What is your age? Please select Under 18 18-24 years 25-34 years 35-44 years 45-54 years 55-64 years 65-74 years 75-84 years 85-94 years 95 years + Prefer not to say
What is the highest degree or level of school that you have completed? Please specify
Is there anything else you'd like us to know?