PROGRAM APPLIED FOR :

Address :

CURRENTLY MEDICALLY CLEARED FOR DIVING :

KNOWN ALLERGIES (IF NONE WRITE “NKDA”):

WORK SCHEDULE FLEXIBLE?:

PLEASE INDICATE DATES OF SERVICE AND TYPE (ACTIVE DUTY, RESERVE, GUARD, IRR, ETC):

SERVICE-CONNECTED DISABILITY RATING :

*NOTE: PLEASE PROVIDE CURRENT VETERANS AFFAIRS CIVIL SERVICE PREFERENCE LETTER TO CONFIRM SERVICE-CONNECTED DISABILITY STATUS (POWERPOINT INSTRUCTIONS ARE LOCATED AT THE BOTTOM OF THIS PAGE FOR HOW TO DOWNLOAD LETTER FROM THE VA E-BENEFITS WEBSITE).
Please also provide a DD214 with your SSN, and any other personal data which you do not wish to share, blocked out. All supporting documents may be emailed to getwet@operationaquaticfreedom.org. Please include your name, program applied for, and date of application in the body of your email to our team along with supporting documents.

PLEASE INDICATE IF PURPLE HEART RECIPIENT :

MOS/AFSC/NEC HELD:

CAMPAIGNS SUPPORTED - NO OPSEC VIOLATIONS :

ARE YOU CURRENTLY SERVING IN THE UNITED STATES ARMED FORCES? IF YES, INDICATE SERVICE TYPE, BRANCH, RANK, MOS/AFSC/NEC, AND DUTY STATION - NO OPSEC VIOLATIONS

PLEASE LIST ALL PERSONAL DIVING EQUIPMENT CURRENLTY OWNED AND INSPECTION DUE DATES (IF APPLICABLE):

*NOTE:FUTHER CONSENT PAPERWORK WILL BE PROVIDED AT PROGRAM ENTRY

DO YOU CONSENT TO PARTICIPATE IN A LICENSED, AND INSURED, PSYCHOLOGIST’S INTERVIEW PRE, MID, AND POST PROGRAM SURVEY OF THE CLINICAL EFFECTS OF SCUBA DIVING ON THE SIGNS AND SYMPTOMS OF POST-TRAUMATIC STRESS SYDROME, ANXIETY, DEPRESSION, ETC?

DO YOU HAVE ANY SPECIAL TRAVEL OR ACCOMMODATION REQUESTS

IF YES, TO THE ABOVE QUESTION, PLEASE EXPLAIN IN THE SUPPLEMENT SECTION.

HOW DID YOU HEAR OF OPERATION AQUATIC FREEDOM :

PLEASE PROVIDE EMERGENCY CONTACT INFORMATION BELOW:

SUPPLEMENT SECTION

PLEASE ENSURE TO REFERENCE QUESTION/AREA TO WHICH MORE INFORMATION IS BEING PROVIDED

VA Service-Connected Letter PPT

Operation Aquatic Freedom is a Service-Connected Disabled Veteran proudly owned, staffed, and operated IRS 501(c)(3) tax-exempt charitable foundation: Tax ID # 82-2307898.
Please, be safe and know your charity before donating!

It is the strict policy of Operation Aquatic Freedom, as well as in accordance with federal laws governing charitable organizations, to never contribute to, endorse, oppose, nor attempt to influence in any way, a political candidate, campaign, movement, legislation, or ideology. Any opinions expressed by the organizations which Operation Aquatic Freedom engages with, or are sponsored by, are the sole opinions of that individual organization and not those of Operation Aquatic Freedom. All content © 2018 Operation Aquatic Freedom