ANG Exit Questionnaire

Welcome, Separatee

Congratulations on completing your active duty service commitment. This questionnaire helps determine whether the Air National Guard is a good fit for your next chapter. Your answers are confidential and used only to connect you with the right opportunities. Takes about 5–7 minutes.

Section 1 of 9

Personal Information

We use this to identify your record and contact you. No SSN is collected.

Rank * Please select your rank.

Full Name * Please enter your full name.

Personal Email * Please enter a valid email address.

Cell Phone * Please enter your cell phone number.

AFSC * Please enter your AFSC.

Base Assigned * Please enter your assigned base.

Separation Date * Please select your separation date.

Terminal Leave Date (optional)

Step 1 of 9

Section 2 of 9

After Separation

Tell us about your plans following your service.

Where do you plan to live after separation? * Please enter a city and state.

Have you secured a civilian job? *

Yes No Pending / Interviewing

Please select an option.

What will you be doing?

Planning to attend school or technical training? *

Yes – College / University Yes – Technical / Trade School No Undecided

Please select an option.

Have you researched medical and dental insurance options outside the military? *

Yes No In Progress

Please select an option.

Step 2 of 9

Section 3 of 9

What you'll miss most

Check everything that resonates with you.

Other experiences you valued (optional)

Step 3 of 9

Section 4 of 9

What you won't miss

Honest feedback helps the ANG improve. Check all that apply.

Anything you'd like to explain further? (optional)

Step 4 of 9

Section 5 of 9

Reason for Separating

Select the primary reason you are separating.

Why are you separating? * Please select a reason.

Additional context (optional)

Step 5 of 9

Section 6 of 9

Fitness Assessment

Enter your most recent fitness test results.

Last Fitness Test Date * Please enter your last fitness test date.

Score *

0–100 point scale

Please enter your fitness score.

Rating achieved

Excellent (90–100) Satisfactory (75–89.9) Unsatisfactory (<75)

Were any components exempted? *

No exemptions Cardio exempted Strength components exempted Full exemption (medical)

Please select an option.

Step 6 of 9

Section 7 of 9

Medical & Administrative

This information is used to assess ANG eligibility. Answers are reviewed by the recruiter only.

Are you currently on a Medical Profile? *

Yes No

Please select an option.

Please describe the profile and any limitations

Are you on a Control Roster or UIF? *

Yes No

Please select an option.

Please explain the circumstances

Step 7 of 9

Section 8 of 9

Service Plans & ANG Interest

Are you considering continued military service?

Are you joining another military service? *

Yes No Considering it

Please select an option.

Which branch?

How interested are you in ANG opportunities? *

🔥 Very Interested — tell me everything 🤔 Somewhat Interested — open to hearing more Not Interested at this time

Please select your interest level.

Step 8 of 9

Section 9 of 9

ANG Preferences & Contact

Help us connect you with the right unit and time to reach you.

Preferred ANG State (optional)

Desired ANG Unit (if known)

Best time to contact you (select all that apply)

Would you like a benefits briefing? *

Yes — I'd like to learn about ANG benefits No thanks Maybe later

Please select an option.

Would you like information on full-time ANG opportunities (AGR/Technician)? *

Yes — I'm interested in full-time roles No — part-time only for now Open to hearing more

Please select an option.

Anything else you'd like your recruiter to know? (optional)

Step 9 of 9

✓

Questionnaire Submitted

Thank you for your service and for taking the time to complete this. Your recruiter will review your responses and reach out soon.

Your Recruiter

MSgt Jessica Prigmore
Air National Guard Recruiter
📞 650-335-8415
✉️ jessica.prigmore@us.af.mil