855-OUR-WOUNDED (855-687-9686)
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Apply for Grant

The Wounded Marine Fund

1902 Wright Place, 2nd Floor
Carlsbad, CA 92008

This application is intended to provide information that will guide The Wounded Marine Fund, Inc. in the selection of beneficiaries according to its Beneficiary Selection Policy.  The information provided herein shall be held in strict confidence.

Your Name:

Your Email:

Are you now or were you a U.S Marine on the date of your injuries: YesNo

Rank:

Date of Birth:

Place of Birth:

Current Residence:

Do you intend to leave the Marine Corps? YesNo

If so, do you have an approximate date? :

If so, will you be staying in California? YesNo

Are your wounds combat related? YesNo

Please provide a complete list of your injuries sustained in combat and the prognosis of each:

Are you married? YesNo

Do you have children? YesNo

Are you willing to speak publicly about your story (TV, Radio, Newspaper etc…)? YesNo

Are you willing to appear at fundraisers benefiting “The Wounded Marine Fund,” if asked to do so? YesNo

Are you willing to act in a responsible manner at any events related to “The Wounded Marine Fund?” YesNo

Are you willing to provide pictures of your injuries if asked? YesNo

Will you cooperate fully with any representative of “The Wounded Marine Fund” when asked to do so, for the benefit of the Fund? YesNo

What was the date and place of your injuries?

How do you feel about your injuries?

Please tell us your story (why you joined the Marines, how you were wounded, your treatment, goals and aspirations etc…)