Completing this application is the first step in being considered for placement in a 2019 theraputic fly-fishing experience.


 PLEASE READ every section in their entirety and answer accordingly.


We thank you for your service to our country and for your interest in Warriors and Quiet Waters (WQW).


This process may include a brief phone interview, further questions, and additional emails.


Prompt responses to additional questions are appreciated.


Selection for our program is not guaranteed even if all program criteria is met. Selection is at WQW's discretion and we appreciate your understanding.

Contact Information

* If you are the Caregiver of a service member and applying for our Caregiver Fishing Experience (FX) please fill in with YOUR name and contact information.


Under the "PERSONAL/MILITARY" information section, please fill in for your care recipient.


Please state in the ADDITIONAL COMMENTS section that you are applying as a Caregiver.*



**Name as it appears on Federal or State Identification Card**

State / Province*
Best Email (checked regularly)*
Confirm Email*
How did you hear about WQW? If by "WQW Alumni Referral" please state the name of the alumnus in the additional comments section. If by "Referral," please state the name/organization/contact of referral in the additional comments section.*
  • WQW Alumni Referral
  • Referral
  • Website
  • Social Media
  • Other

Personal/Military Information

  • Male
  • Female
Marital Status*
  • Married
  • Single
  • Divorced
  • Widowed
Military Branch.*
  • USMC
  • ARMY
  • NAVY
Active Duty Currently*
  • Yes - List current command in the additional comments section and you may be asked to submit an ERB, SRB or similar service documentation
  • No - DD214 Member-4 is requested at time of application
Purple Heart Recipient*
  • Yes
  • No

The next question asks to list any *COMBAT RELATED* wounds or conditions. "Combat Related" is defined as wounds or diagnosed conditions that are a direct result of enemy contact (conditions include PTSD and TBI); NOT an illness, injury or condition acquired while deployed, in training, or CONUS. 



If comfortable, please provide a brief summary of any *COMBAT RELATED* conditions.
Deployment Information: Theater(s) of Operation (OIF, OEF, OND), years, unit(s) etc. EXAMPLE: "OEF - Sangin, Afghanistan - with 1/7"*
Tell us briefly why you would like to participate in a WQW FX and in what ways you feel our program can benefit you.*
Facebook name (If you do not have an account please fill with "N/A")*
Instagram Handle
Twitter Handle

If you are NOT active duty, please answer the following question:

What are you doing right now? Are you gainfully employed? Are you in school? Are you a single parent? Please tell us more.*


Please send your DD214 MEMBER-4  AT THE TIME OF APPLICATION SUBMISSION. Your selection evaluation WILL NOT begin until a DD214 or other service documentation has been received.


**ACTIVE DUTY - Please state in the additional comments if you have an updated ERB, SRB or similar on hand to submit.


Both Active and separated, please feel free to omit your Social Security and DOB when submitting but please know that we take personal records very seriously and your personal identifying information will not be shared with any other entity or person and is all stored securely


ALSO, please send over a CURRENT PHOTO of yourself.


Methods of sending include:

  • Scanned PDF
  • A clear smart phone photo
  • JPEG

Email the document(s) and photo to or upon completion of this application.

Additional Comments