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When filling out the online Segs4Vets application please complete all of the required fields.  If you would like a copy of your application e-mailed to you please check the box at the bottom of the page.

 

Applications will be assessed and selection of recipients made by a panel of members chaired by a retired member of the United States military. Please provide as much information as you are comfortable providing which could enhance your chances of being selected as a Segs4Vets recipient, including your hometown, and your plans for your future.

 

Prior to being selected as a Segs4Vets recipient DRAFT will require a favorable assessment by your physical/occupational therapist regarding your ability to safely use a Segway as a tool which would enhance the quality of your life.

 

The Segs4Vets program prepares biographies for the Segs4Vets recipients similar to those shown on our website and issues press releases containing biographical information about our recipients. If you do not wish your biographical information to be released please indicate that desire in the provided area of the application. Segs4Vets awards are not contingent upon you agreeing to have your biographical information released.

 

Prior to awarding Segways to Segs4Vets recipients, DRAFT will require that you complete training provided by DRAFT.

 

For further information contact Segs4Vets@draft.org

 
Download Application
 

Segs4Vets Nomination Application

 

Eligibility for DRAFT's Segs4Vets program is currently restricted to members or former members of United States military who while on active duty on or after September 11, 2001 while serving under one of the following conditions:

 

Armed Conflict

Hazardous Service

Conditions Simulating War

Instrumentality of War

Combat Operation

Combat Zone

 

incurred illness or injury resulting in permanent disability. 

 

If you meet this criteria or believe you meet this criteria please fill out the online form below.
First Name*
Last Name*
Address*
City*
State*
Zip Code*
E-Mail Address*
Phone Number*
Gender*
Birth Date*
Where did you attend High School (City, State)
Where do your parents live(City, State)?
Branch of Service*
Rank*
Component
Are you still on active duty?
Date of discharge
Is your disability rating
Disability Rating
or Estimated Disability Rating
Circumstances surrounding Injury*
Date of Injury*
Type of Injury*
Medals Awarded
Your Physical/Occupational Therapist Contact Information*
Have you ever used a Segway?
How will a Segway help you?
Other Information
Permanent Address (if different than above)
City
State
Zip Code
Upload JPEG Photographs

File Size: 1000KB Maximum
File Types: .jpg .jpeg
Permission to disclose biographical information*
Submit
*Required
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