WARRIOR APPLICATION

Completing this application is the first step in being considered for placement in a 2018 theraputic fly-fishing experience. We thank you for your service to our country and for your interest in WQW.

 

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

Contact Information

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

Country
State / Province*
Address
City
Best Email (checked regularly)*
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 REQUESTED 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(s) 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 REQUESTED 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