PROGRAM APPLICATION

BATTLEWORN FOUNDATION EXISTS TO SERVE MILITARY MEMBERS, FIRST RESPONDERS, AND THEIR FAMILIES WHO CARRY THE SILENT WEIGHT OF SERVICE, TRAUMA, AND THE BATTLES OF EVERYDAY LIFE. THROUGH RESILIENCY PROGRAMS, OUTREACH AND ONGOING ACCOUNTABILITY, BATTLEWORN HELPS RECLAIM PURPOSE, RESTORE HOPE, AND EQUIP LIVES FOR LASTING TRANSFORMATION.

APPLICATION PROCESS

THIS APPLICATION IS INTENDED FOR MILITARY MEMBERS, VETERANS, FIRST RESPONDERS, QUALIFYING SPOUSES, AND FAMILY MEMBERS SEEKING PARTICIPATION, ASSISTANCE, OR SCHOLARSHIP SUPPORT THROUGH BATTLEWORN FOUNDATION PROGRAMS.

ELIGIBILITY REVIEW

APPLICATIONS ARE REVIEW ON A CASE-BY-CASE BASIS. SUBMISSION DOES NOT GUARANTEE ACCEPTANCE, SCHOLARSHIP FUNDING, TRAVEL ASSISTANCE, OR PROGRAM PLACEMENT. BATTLEWORN FOUNDATION MAY REQUEST ADDITIONAL INFORMATION TO VERIFY ELIGIBILITY AND ENSURE PROPER CARE.

APPLICANT TYPE *

HOW TO COMPLETE THIS APPLICATION

PLEASE COMPLETE EACH SECTION TRUTHFULLY AND THOROUGHLY. REQUIRED DETAILS HELP BATTLEWORN FOUNDATION ASSESS FIT, SAFETY, SCHOLARSHIP NEEDS, TRAVEL CONSIDERATIONS, AND APPROPRIATE FOLLOW-UP. MEDICAL DETAILS ARE REQUESTED FOR PARTICIPANT CARE AND EMERGENCY PLANNING

MONTANA RESIDENT *

PREFERRED PROGRAM *

SELECT AN OPTION

DATE SUBMITTED *

FIRST NAME *

MIDDLE

LAST NAME *

STREET ADDRESS *

CITY *

STATE *

COUNTRY *

POSTAL CODE *

EMAIL ADDRESS *

PHONE *

Confirm Phone Number and make sure the number is different from your spouse’s number. (OUR SYSTEM WILL NOT ALLOW PHONE NUMBERS USED IN PREVIOUS APPLICATIONS).

NEAREST MAJOR AIRPORT / TRAVEL HUB *

WHAT IS THE CITY OF THIS AIRPORT? *

WHAT IS THE STATE OF THIS AIRPORT? *

HAVE YOU PREVIOUSLY APPLIED FOR OR ATTENDED A BATTLEWORN PROGRAM? *

IF YES, PLEASE EXPLAIN WHEN, WHERE, AND UNDER WHAT PROGRAM?

DATE OF BIRTH - MM/DD/YYYY *

MARITAL STATUS *

RELIGIOUS AFFILIATION (IF ANY)

HEIGHT *

WEIGHT *

T-SHIRT SIZE *

SPOUSE NAME *

SPOUSE PHONE / EMAIL *

CHILDREN / DEPENDENT *

BRIEFLY DESCRIBE YOUR CURRENT FAMILY SITUATION AND ANY SUPPORT NEEDS: *

WHAT DO YOU HOPE BATTLEWORN FOUNDATION CAN HELP CULTIVATE IN YOUR LIFE OR FAMILY? *

HOW SOON WOULD YOU LIKE/BE ABLE TO ATTEND? *

Please select an option that would match your availability.

WHAT WOULD YOU LIKE TO GET OUT OF OUR PROGRAM? *

REFERRAL SOURCE - HOW DID YOU HEAR ABOUT US? *

SELECT AN OPTION

EMERGENCY CONTACT FIRST NAME *

EMERGENCY CONTACT LAST NAME *

RELATIONSHIP *

EMERGENCY CONTACT PHONE NUMBER *

EMAIL ADDRESS (EMERGENCY) *

ALTERNATE PHONE NUMBER (EMERGENCY)

ADDRESS / CITY / STATE

ANYTHING BATTLEWORN FOUNDATION SHOULD KNOW ABOUT CONTACTING THIS PERSON IN AN EMERGENCY?

NAME (SECOND)

RELATIONSHIP (SECOND)

PHONE (SECOND)

CURRENT MEDICATIONS (IF NONE, PLEASE WRITE "NONE") *

(For medical emergency purposes only, if none, please annotate 'None'.)

CURRENT MEDICAL ISSUES, INJURIES, CONDITIONS, OR LIMITATIONS *

(i.e. PTSD, Depression, Anxiety, Seizures, etc.) Please explain.

FOOD ALLERGIES (IF NON, PLEASE WRITE "NONE")

MEDICATION ALLERGIES (IF NONE, PLEASE WRITE "NONE")

PRESCRIPTION EYEWEAR USED

WILL YOU REQUIRE ASSISTANCE WITH DRESSING, BATHING, EATING, MOBILITY, TRAVEL, OR OTHER BASIC NEEDS?

i.e. Dressing, Bathing, Eating, etc.

FITNESS, RISK, LIMITATION, AND PROGRAM COMPLETION ACKNOWLEDGMENT

I understand that participation may be uncomfortable, difficult, strenuous, or challenging at times, and that I may be asked to participate in activities that require physical effort, emotional honesty, spiritual reflection, teamwork, discipline, and perseverance.

I acknowledge that I am responsible for disclosing any known medical condition, injury, disability, physical limitation, mental health concern, mobility restriction, medication, allergy, dietary restriction, or safety concern that may affect my ability to participate safely.

I certify that I have disclosed all known limitations, restrictions, medical conditions, injuries, mental health concerns, medications, allergies, dietary restrictions, or other safety-related concerns that may affect my participation or the safety of others.

I understand that failure to disclose relevant limitations, restrictions, conditions, or concerns may affect my safety, the safety of others, and Battleworn Foundation's ability to provide appropriate care, support, or accommodations.

I understand that Battleworn Foundation may request additional information, modify my participation, restrict certain activities, or decline participation if safety, medical, behavioral, spiritual-care, or program-fit concerns exist.

I understand that acceptance into a Battleworn Foundation program does not guarantee successful completion or graduation.

I understand that Battleworn Foundation will make reasonable efforts to meet me where I am physically, mentally, spiritually, and emotionally, but I am still expected to engage honestly, participate in all required activities to the best of my ability, and remain committed throughout the program.

I understand that graduation or completion may be withheld if I refuse to participate, quit, fail to disclose relevant limitations, violate program expectations, present a safety or behavioral concern, or otherwise fail to complete the required components of the program.

I understand that Battleworn Foundation is not requiring perfection, elite fitness, or performance at another participant's level. I understand that the expectation is honesty, effort, participation, and a willingness to stay in the fight.

AGENCY / DEPARTMENT / UNIT

RANK / POSITION *

BRIEFLY DESCRIBE YOUR SERVICE BACKGROUND, DEPLOYMENTS, ASSIGNMENTS, OR RESPONDER EXPERIENCE. *

PLEASE UPLOAD YOUR MILITARY OR SERVICE DOCUMENTS.

Click to upload

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF DD-214

ANYTHING ELSE BATTLEWORN FOUNDATION SHOULD KNOW ABOUT YOUR SERVICE HISTORY?

TERMS *

I have read and understand the terms above.

I affirm that the information provided is accurate and complete.

I authorize Battleworn Foundation to contact me regarding this application and related next steps.

I understand medical information is requested for participant care, safety, and emergency planning. *

Travel Assistance Request: If applicable, explain airfare, mileage, lodging, or other transportation

Full Legal Name as it appears on Government ID *

Please provide the name as it appears on your Federal / State Government Issued ID, i.e. Drivers License, State ID, Retired Military, etc. (Include Middle Name or Middle Initial)

Signature *

Clear

Date

Captcha

Battleworn Foundation uses SMS to communicate with individuals who voluntarily submit an online application through our website. Messages are sent only to applicants who provide their phone number and consent to receive text updates. SMS messages may include application receipt confirmations, application review updates, next-step instructions, scheduling reminders, program communication, and follow-up related to the applicant’s participation or interest in Battleworn Foundation programs. We do not use this number to send unrelated third-party marketing or sell contact information.