Caregiver 2024 Application

Thank you for your interest in our WQW Caregiver Program! We are honored to serve those that give so much of themselves to care for the Post-9/11 Combat Veterans in their lives.

Please fill out the below application. We recommend short answer responses of about 100-150 words, so that you can tell us your story and about why this program is right for you!

A note about Personal Information:

WQW exercises absolute discretion and responsibility in how we use and store personal information.
Certain elements of information will help us determine whether you are a good fit for our programs.
Your responses allow us to get to know you and the various circumstances and factors that affect your life.
All of it together will help us to put Warriors first, always. Thank you for taking the time to provide it.

General Information

First Name (as shown on I.D.)

Middle Name

Last Name

Preferred First Name

Mailing Address

City

State

Zip Code

Preferred Phone

MobileHomeWork

Home Phone

Mobile Phone

Work Phone

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

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

Please write "NA" if you do not have any of the social media accounts:

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, either through the receipt of combat awards or proof of service in a location in which you received Imminent Danger Pay.

If you are applying as a caregiver, please include your care recipient's service record (DD214 Member-4, ERB, ORB, BIR, BTR, etc.). We recognize that service records are confidential and are stored securely.

Check the following locations on the DD214 to ensure eligibility (only one of the following requirements must appear):

Block 13: Decorations Medals, Badges, Citations, and Campaign Ribbons (check the continuation page for overflow of Block 13 information).
Block 18: Remarks. This is where you will find information about receiving Imminent Danger Pay.

If you do not see confirmation of participation in combat operations on the DD214, or if your care recipient is currently Active Duty or does not possess a DD214, please provide any official documentation of combat related service. This can include, but is not limited to:

Award Citations for Combat Awards (ie. Purple Heart, Combat Action Ribbon/Badge/Medal, Bronze Star with "V" device, etc.)
Service Record (which clearly indicates combat service and/or deployment information)

Upload Service Record (.jpg, .jpeg, .png, .tif)

Upload Current Photo (Caregiver) (.jpg, .jpeg, .png, .tif)

2024 Program Applications are now open. Apply Now! |

Learn More

WQW Caregiver Application

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