APPENDIX
E
FAMILY
SUPPORT GROUP (FSG) QUESTIONNAIRE
NOTICE for Activities: A Privacy Act Statement must be furnished to the individual before this form is completed
Name__________________________________________________________________________________________
Military member's name______________________________________________Co._______________________
Home Address__________________________________________________ Phone_________________________
Work Phone____________________________
Housing Area__________________________________________________________________________________
Children______________________________________________________________________________________
(name) (age)
Do you have transportation___________________Yes________No_______
Do you speak a language other than, in addition to, English?__________________________________
If so, which language?________________________________________________________________________
Do you have any other family in the area?_____________________________________________________
Telephone of other area family members________________________________________________________
Name and telephone number of local friend or neighbor_________________________________________
Other than your spouse, who would you notify in case of
emergency?_______________________________________________________________________________
Are you expecting a baby?_______________________ Due date_____________________________________
Hospital_______________________________________________________________________
Are you willing to assist other family members in your unit?__________________________________
_______________telephoning?
_______________babysitting?
_______________occasional transportation in your housing area?
_______________planning company activities
_______________assisting your company newsletter representative?
_______________other?
What would you like to see the FSG accomplish?
Do you have any skills/talents that you would be willing to share
with a small group?
Do you have any special interests/concerns that a resource person
(speaker) could talk about at an FSG meeting?
Table
of Contents
Appendix
D: Responsible Agency Matrix
Appendix
F: How to Survive Deployment
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