WQW Application

PLEASE READ every section in its entirety and answer accordingly. You will need a clear, current photo (a selfie or Facebook profile photo within the last year), and a Member-4 DD214 or service record if active duty to complete this application.

Completing this application is the first step in being considered for selection and placement in a Warriors & Quiet Waters (WQW) Fly-Fishing Experience (FX). This process may include a brief phone interview, further questions, and additional emails. Prompt responses to additional communications are appreciated.

This application is for our Solo/Women or Caregiver FX types only. If you are inquiring about our other programs, please know that they are generally reserved for our alumni who have attended the FX types mentioned above.

Selection for WQW programs is not guaranteed EVEN IF all program criteria are met. Selection is solely at WQW's discretion. We appreciate your understanding.

General Information

Are you applying as a Warrior or Caregiver?

WarriorCaregiver

First Name

Middle Name

Last Name

Mailing Address

City

State

Zip Code

Phone Number

Date of Birth

Gender

Race

Ethnicity

Marital Status

Do you have children? (including if you have step or foster children, or if you are a legal guardian)

YesNo

How many Minor Children do you have (including if you are a legal guardian or have step or foster children)?

How many Adult Children do you have (including if you are a legal guardian or have step or foster children)?

What are the ages and gender of your children?

What is your employment and/or student status?

Please further describe your employment and/or student status

Military Information

What year did you enter the military?

What service did you enter with?

Are you either active duty or in a drill status with the National Guard/Reserves?

What was your last or current rank in the military?

What was your end of service year?

During your most recent combat deployment, what service were you a member of?

How many times have you been deployed to a combat zone?

What year was your first post-9/11 combat deployment?

What year was your most recent post-9/11 combat deployment?

Other service information: Theater(s) of Operation (OIF, OEF, OND), unit(s), MOS, anything else you would like to share

Are you a Purple Heart Recipient? Please note a Purple Heart is NOT required to qualify for WQW programs.

If you're comfortable sharing, can you please tell us the circumstances of why you received it:

The next question asks to list any *COMBAT-RELATED* wounds or conditions.

"Combat-related" is defined as wounds or conditions that are a DIRECT RESULT of enemy contact. Combat-related DOES NOT include: illness, injury, or conditions acquired while in training, CONUS, or while deployed and not during enemy contact.

Please select from the drop-down if applicable, and if comfortable, please provide a brief summary of *COMBAT-RELATED* wounds or conditions in the text area below (this includes visible and invisible conditions).

Do you have any of the following combat-related wounds or conditions?

Is there anything else you'd like us to know about any conditions you may have?

Other Warrior Information

How did you learn about WQW?

If you were referred (including through alumni, staff, volunteer), by whom? Please tell us their name

Tell us why you would like to participate in a WQW FX:

Tell us, in 100 words or more, in what ways you feel our program could benefit you:

Social Media

Facebook URL

Instagram Handle

Twitter Handle

Submission of Service Record and Current Photo

WQW's Program Team is committed to objectivity when reviewing applications. This thorough screening process requires confirmation of participation in combat operations.

Please include your service record (DD214 Member-4, ERB, ORB, BIR, BTR, etc.). By submitting below, you provide a tool that helps our staff confirm qualification criteria is met. We recognize that service records are confidential and are stored securely.

Upload Service Record (.jpg, .pdf, .png)

Upload a current photo of yourself (.jpg, .pdf, .png). This can be a selfie or facebook profile photo or other within the last year

Other Caregiver Information

How did you learn about WQW?

If you were referred (including through alumni, staff, volunteer), by whom? Please tell us their name

Tell us why you would like to participate in a WQW FX:

In what ways do you feel our program could benefit you (i.e. self care, respite, discovering a new activity, etc)?

Social Media

Facebook URL

Instagram Handle

Twitter Handle

Submission of Service Record and Current Photo

WQW's Program Team is committed to objectivity when reviewing applications. This thorough screening process requires confirmation of participation in combat operations.

If you are applying as a caregiver, please include your care recipient's service record (DD214 Member-4, ERB, ORB, BIR, BTR, etc.). By submitting below, you provide a tool that helps our staff confirm qualification criteria is met. We recognize that service records are confidential and are stored securely.

Upload Service Record (.jpg, .pdf, .png)

Upload Current Photo of Yourself (.jpg, .pdf, .png)

Caregiver and Caregiver Recipient Info

Did you serve in the Military?

YesNo

With what Branch of Service?

How long have you been a caregiver?

What is your relationship to your care recipient?

Care Recipient Service History

To ensure you are surrounded by other resilient caregivers facing similar challenges, it is helpful for us to know about your care recipient.

Is your Care Recipient a post-9/11 combat veteran?

Does your Care Recipient have a Purple Heart?

If you know, please list your Care Recipient's deployment information: Theater(s) of Operation (OIF, OEF, OND), years, unit(s) etc.

The next question asks to list any *COMBAT-RELATED* wounds or conditions that your care recipient has. "Combat-related" is defined as wounds or conditions that are a DIRECT RESULT of enemy contact.

Thank you for your service to our country and your interest in WQW!

Contact Information