AWA Program Application
Applicant Name
*
First Name
Middle Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
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12
13
14
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16
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18
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21
22
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24
25
26
27
28
29
30
31
Day
Please select a year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
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1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Address
*
Street Address
Street Address Line 2
City
State
Zip Code
E-mail
*
example@example.com
Mobile Number
*
Marital Status
*
Single
Married
Divorced
Widow/Widower
Children
*
Yes
No
Attending the Mens or Womens program
*
Mens
Womens
Womens dates - select any you are interested in
FEB 03 - FEB 07 2025
FEB 24 - FEB 28 2025
MAR 24 - MAR 28 2025
APR 14 - APR 18 2025
APR 28 - MAY 02 2025
MAY 05 - MAY 09 2025
MAY 12 - MAY 16 2025
JUN 09 - JUN 13 2025
JUN 23 - JUN 27 2025
JUL 14 - JUL 18 2025
JUL 21 - JUL 25 2025
AUG 18 - AUG 22 2025
AUG 25 - AUG 29 2025
SEP 29 - OCT 03 2025
OCT 27 - OCT 31 2025
NOV 10 - NOV 14 2025
Mens dates - select any you are interested in
FEB 03 - FEB 07 2025
FEB 24 - FEB 28 2025
MAR 31 - APR 04 2025
APR 28 - MAY 02 2025
MAY 05 - MAY 09 2025
MAY 12 - MAY 16 2025
JUN 09 - JUN 13 2025
JUN 23 - JUN 27 2025
JUL 21 - JUL 25 2025
AUG 18 - AUG 22 2025
AUG 25 - AUG 29 2025
SEP 29 - OCT 03 2025
OCT 27 - OCT 31 2025
NOV 10 - NOV 14 2025
DEC 01 - DEC 05 2025
What led you to reach out to the American Warrior Association
*
Family Communication Issues
Challenges in Marriage
Support to work through mental health issues
Moral 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
*
Yes
No
Currently Serve
Branch of Service
*
Air Force
Army
Coast Guard
Marines
Navy
Other
Military Service Start Date
*
-
Month
-
Day
Year
Start Date
Military Service End Date
-
Month
-
Day
Year
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
*
Yes
No
Currently Serve
What City are you a First Responder for
*
Start Date of FR Service
*
-
Month
-
Day
Year
Date
End Date of FR Service
-
Month
-
Day
Year
Date
Occupation
*
EMT
Fire Fighter
Nurse
Paramedic
Police
Other
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
Yes
No
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
*
Browse Files
Drag and drop files here
Choose a file
Veterans attach a DD214. Current military members, attach current orders or equivalent. First Responders please upload credentials or Agency Issued ID..
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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
*
Yes
No
Inhibit or limit you from hiking, horseback riding, camping, fishing, or other outdoor physical activities
*
Yes
No
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
*
Yes
No
Any food allergies or dietary restictions
*
Yes
No
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-Partner
Family
Friend
Other
Have you attended an AWA program before
*
Please Select
Yes
No
T-shirt Size
*
Please Select
XS
Small
Medium
Large
XL
XXL
XXXL
How did you hear about our Programs
*
Friend/Family
Google Ad
Social Media
Workplace / Coworker referral
Attachment Name
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