AWA Program Application

AWA Program Application
Applicant Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState

Zip Code
E-mail*
example@example.com
Mobile Number*
Marital Status*

SingleMarriedDivorcedWidow/Widower
Children*

YesNo
Attending the Mens or Womens program*

MensWomens
Womens dates - select any you are interested in

FEB 03 - FEB 07 2025FEB 24 - FEB 28 2025MAR 24 - MAR 28 2025APR 14 - APR 18 2025APR 28 - MAY 02 2025MAY 05 - MAY 09 2025JUN 09 - JUN 13 2025JUN 23 - JUN 27 2025JUL 14 - JUL 18 2025JUL 21 - JUL 25 2025AUG 18 - AUG 22 2025AUG 25 - AUG 29 2025OCT 13 - OCT 17 2025OCT 27 - OCT 31 2025NOV 03 - NOV 07 2025
Mens dates - select any you are interested in

FEB 03 - FEB 07 2025FEB 24 - FEB 28 2025MAR 31 - APR 04 2025APR 28 - MAY 02 2025MAY 05 - MAY 09 2025MAY 12 - MAY 16 2025JUN 09 - JUN 13 2025JUN 23 - JUN 27 2025JUL 14 - Jul 18 2025JUL 21 - JUL 25 2025AUG 18 - AUG 22 2025AUG 25 - AUG 29 2025SEP 01 - SEP 05 2025SEP 29 - OCT 03 2025OCT 13 - OCT 17 2025OCT 27 - OCT 31 2025NOV 10 - NOV 14 2025DEC 01 - DEC 05 2025
What led you to reach out to the American Warrior Association*

Family Communication IssuesChallenges in MarriageSupport to work through mental health issuesMoral Injury or Trauma Support
Service History

Military must have served a minimum of 24 months after basic training to be eligible for program.
Have you served in the Military*

YesNoCurrently Serve
Branch of Service*

Air ForceArmyCoast GuardMarinesNavyOther
Military Service Start Date *

MonthDayYear
Start Date
Military Service End Date

MonthDayYear
Estimated separation date
Describe your time in the Military*
Briefly describe your time in the Military, including assignments, deployments and the highs and lows of your time in service.
Have you served as a First Responder*

YesNoCurrently Serve
What City are you a First Responder for*
Start Date of FR Service*

MonthDayYear
Date
End Date of FR Service

MonthDayYear
Date
Occupation*

EMTFire FighterNurseParamedicPoliceOther
Describe your time as a First Responder*
Briefly describe your time as a First Responder, including assignments, utilizations, and the highs and lows of your time in service.
Are you the spouse of a military member, veteran, or first responder

YesNo
Describe how this has affected you
Attach file

Upload is limited to one file. Your file cannot have any special characters in its' name. Veterans, please attach your DD214. Current service members, please attach your orders or equivalent. First Responders please attach your credentials or agency issued ID card. If you have served in multiple capacities, only upload the most recent form/proof/id.
Attach your file*

Veterans attach a DD214. Current military members, attach current orders or equivalent. First Responders please upload credentials or Agency Issued ID..
Cancelof
Medical Information

Are there any medical issues or physical limitations that would...?
Impede your ability to participate in a small group situation in a remote location*

YesNo
Inhibit or limit you from hiking, horseback riding, camping, fishing, or other outdoor physical activities*

YesNo
Please explain why
If you answered "YES" to either of the above, please explain why.
Please list your current medications*
For medical emergency purposes only.
Does your physician require a medical release*

YesNo
Any food allergies or dietary restictions*

YesNo
Please list any food allergies or dietary restrictions
References

In the box below, list 2 family, friend or mentor references. Please provide Name, Phone, Email and relationship to reference

References

	Full Name	Phone Number	Email	Relationship
Reference 1
Reference 2

Emergency Contact Information (ICE)
ICE Full Name*
ICE Contact*
Please enter a valid phone number.
Relationship*

Spouse-PartnerFamilyFriendOther
Have you attended an AWA program before*
T-shirt Size*
How did you hear about our Programs*

Friend/FamilyGoogle AdSocial MediaWorkplace / Coworker referral
Attachment Name
Should be Empty:

AWA Program Application

Service History

Attach file

Medical Information

References

Emergency Contact Information (ICE)