WARRIOR APPLICATION

Completing this application is the first step in being considered for placement in a 2017 theraputic fly-fishing experience. We thank you for your service to our country and for your interest in WQW.

Contact Information

Country
State / Province*
Address
City
Email*
Confirm Email*
Phone*
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.*
  • WQW Alumni Referral
  • Referral
  • Website
  • Social Media
  • Other

Personal/Military Information

Gender*
  • Male
  • Female
Marital Status*
  • Married
  • Single
  • Divorced
  • Widowed
Military Branch.*
  • USMC
  • ARMY
  • NAVY
  • AIR FORCE
  • NATIONAL GUARD/RESERVE
  • COAST GUARD
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 REQUIRED TO PROCESS APPLICATION
Purple Heart Recipient*
  • Yes
  • No
Condition(s) Information*
  • Wheelchair
  • Amputee
  • Prosethics
  • Service Dog
  • Difficulty standing for long periods of time
  • Difficulty walking for long distances
  • Difficulty walking on uneven surfaces
  • Vision Impairment
  • Other Assistive Device
  • None

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 of Operation (OIF, OEF, OND), years, unit(s) etc.*
Tell us briefly why you would like to participate in a WQW FX?*

NON-ACTIVE DUTY: DD214 Member-4 REQUIRED TO BEGIN APPLICATION PROCESS

PLEASE SEND YOUR DD214 MEMBER-4 IMMEDIATELY AFTER SUBMITTING YOUR APPLICATION. Your selection evaluation WILL NOT begin until a DD 214 or other service documentation has been received. Methods of sending include:

  • Scanned PDF
  • A clear smart phone photo
  • JPEG

Email the document to saul@warriorsandquietwaters.org

Additional Comments