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Segs4Vets Application Form

The Segs4Vets program is only currently serving members or former members of the United States Armed Forces who while on Active Duty on or after September 11, 2001, while serving under one of the following conditions:

  • Armed Conflict; Hazardous Conditions; Conditions Simulating War; Instrumentality Of War; Combat Operation; Combat Zone; Incurred Illness or Injury resulting in Permanent Disability and Difficulty Walking.

Applications will be assessed and selection of recipients is made by a panel of members chaired by a retired member of the United States Military. Please provide as much information as possible which may enhance your application's chances of being selected as a Segs4Vets recipient, including your plans for the future, and your personal and professional accomplishments.

Prior to being selected to attend a training and assessment, Segs4Vets will require a favorable assessment by your Physical Therapist/ Occupational Therapist/ Doctor regarding your ability to safely operate a Segway as a Mobility device.

We prepare biographies for our Segs4Vets recipients similar to those shown on our website, and prepare press releases containing biographical information about our recipients. If you wish to not have your information released, please indicate that request on question one of the application. Segs4Vets awards are not contingent upon you agreeing to have your biographical information released.

Prior to receiving a Segway you will be required to successfully attend a training and assessment program sponsored by a Segs4Vets/ DRAFT Team, with a favorable recommendation. The Segway and Segvator remain the property of Segs4vets, and if at any time it is requested to be returned to the charity, you fully understand that the charity retains ownership of the device. By submitting the application you fully understand these terms, and agree to return the devices if requested by the charity.

For your application to receive consideration it is vital that you maintain current contact information with us. Please contact us with any changes in your information. 


When filing out your application online it is extremely important to complete EVERY field on the application. Provide as much information as possible, and be very specific. Use specific medical terminology when describing your injury(s)/ illness. Missing information on your application will delay the processing of your application. Triple check your application before submitting, you will receive a confirmation email, at the email you provide on the application, and will be re-directed to the Confirmation page of our website upon successful submission of your application.

Thank You for your Service.
  
Segs4Vets Application Form (Please fill out ALL fields, be specific)