Grassroots Self-Advocate Questionnaire


We’d love to know a little more about you. Please respond to as many questions as you feel comfortable answering. Your responses will help us to better understand you and your amazing story!

Please only answer the questions in the final section if you are a veteran.

If you prefer to complete this as a handwritten form, please download and print this PDF, write your responses, then scan and submit it to


Home Address

About You

Life with Your AbilityOne Job

Life Before Getting Your AbilityOne Job

The Future/Advocacy

Are You a Veteran or a Veteran with a Disability?