Military Warriors Support Foundation - Serving Combat Wounded Veterans

Family Information
Please fill out the information below if you have a spouse or children that you would like to be considered for an event with you.
Family Member 1
Family Member 1 Relationship
Family Member 1 Age
Please enter a number from 0 to 100.
Family Member 2
Family Member 2 Relationship
Family Member 2 Age
Please enter a number from 0 to 100.
Family Member 3
Family Member 3 Relationship
Family Member 3 Age
Please enter a number from 0 to 100.
Family Member 4
Family Member 4 Relationship
Family Member 4 Age
Please enter a number from 0 to 100.
Family Member 5
Family Member 5 Relationship
Family Member 5 Age
Please enter a number from 0 to 100.
Family Member 6
Family Member 6 Relationship
Family Member 6 Age
Please enter a number from 0 to 100.

Medical Information
Disability Percentage
Are you currently taking any medications that would prevent you from participating in any events? If yes, please explain below.
- Yes
- No
If yes, please explain here.*
Do you have a service dog? If yes, please list breed, sex, weight, and if they are current on vaccinations.
Is the animal a certified licensed service animal?
- Yes
- No
Do you, or your family, have any special needs? If yes, please explain.

Demographics
We ask that you complete the following questions which will help MWSF in pursuit of additional funding for its programs through grants and sponsorships. Your answers will not impact your application process. The data collected is protected in accordance with the Privacy Act (93-579). Unauthorized disclosure of this information constitutes a violation of the Privacy Act. You are not required to provide this information, but are encouraged to answer honestly, so that future applicants may continue to benefit from our programs.
Applicant's Gender?*
Which race/ethnicity best describes you?*
What is the highest degree or level of school you have completed? If currently enrolled, highest degree received?*
Age when entered the military*
Number of military years served?
Have you been diagnosed with PTSD?*
Have been diagnosed with a Traumatic Brain Injury (TBI)?*
In the last 12 months have you spent the night in a shelter, mission, church, abandon building, car, park, or street?*

Statement of Truth*
Providing false information can cause a review and change in applicant status and may affect your eligibility to participate in any MWSF program. By submitting the application, you confirm that you all the information contained in it, is truthful to the best of your knowledge. And that you give Military Warriors Support Foundation permission to contact you regarding our programs.
- Agree
- Disagree

Family Information