Sentinels of Freedom

The Sentinels of Freedom Scholarship Foundation is an IRS Approved 501(c)3 Non-Profit Foundation (documentation available upon request).

Sentinels of Freedom Scholarship Program Candidate Questionnaire

1. Please complete this form in its entirety. The Sentinels of Freedom Scholarship Foundation cannot thoroughly evaluate your qualifications unless all information is provided. Blank fields will prevent the online form from being submitted. 2. Please print, complete and sign the Authorization for Disclosure of Information, which gives Sentinels of Freedom permission to contact your caseworkers and other advocates regarding your eligibility for the program. Fax the form to the Sentinels of Freedom Scholarship Foundation at 925.242.8900 once you’ve submitted your questionnaire. Your qualifications cannot be considered until the authorization form is received.
Your Information
Name:	First: Middle: Last:
Rank:
Address:
	City: State: Zip:
	Phone: Email:
Age:
Military branch:	Air Force Army Coast Guard Marines Navy
Years of service:
Unit:
Home of Record:	City: State:
Discharge date:	(date format mm/dd/yyyy)
Projected discharge date:	(date format mm/dd/yyyy)
Commanding Officer's Contact Information
CO's Name:
Address:
	City: State: Zip:
	Phone: Email:
First Sergeant or Chief Contact Information
First Sergeant or Chief:
Address:
	City: State: Zip:
	Phone: Email:
Injury Information
Date injured:	(date format mm/dd/yyyy)
Note: "To qualify, your injury or injuries must have occurred on or after 9/11/2001."
Location when injured:
Combat/Service-related injury?	Yes No
Tell us about your Injury:	characters left (250 characters or less)
Type(s) of injury:	Amputation Blindness Burns Deafness Paraplegia * * “We are currently unable to place injured service members with quadriplegia, Traumatic Brain Injury (TBI) or severe Post-Traumatic Stress Disorder (PTSD).”
Current hospital location:	City: State:
Name of hospital:
VA location:	City: State:
Caseworker's Contact Information
Caseworker's Name:
Address:
	City: State: Zip:
	Phone: Email:
Doctor's Contact Information
Doctor's Name:
Address:
	City: State: Zip:
	Phone: Email:
Tell us more about yourself
Marital status:
No. of dependents:
Ages:
Level of school completed:
For college studies, specify the major area(s) of study and any degree(s) earned:	characters left (250 characters or less)
Military schooling completed:
Military assignments and responsibilities:	characters left (250 characters or less)
Military awards received:	characters left (250 characters or less)
Civilian work experience:	Job 1: characters left (250 characters or less) Job 2: characters left (250 characters or less) Job 3: characters left (250 characters or less)
What are some of your personal goals, and what career fields do you see yourself in?	characters left (250 characters or less)
Are you willing to relocate away from friends and relatives if you're offered a scholarship in another location other than your home of record?	Yes No
If so, where would you like to call home?	City: State: City: State: City: State:
Do you currently own a car or van that has been adapted for special needs and funded by the VA?	Yes No
Are you willing to give Sentinels of Freedom permission to contact you personally, as well as your caseworkers and caregivers, to determine the level of support you will need? Yes No
Do you understand the basic components offered to scholarship recipients and that they are conditional based on adherence to standards set forth in the scholarship recipient agreement? Yes No
How do you see the Sentinels of Freedom Scholarship Program helping you attain your career and life goals?	characters left (250 characters or less)
Are you related (by blood or marriage) or have a business relationship with any director, officer or employee of the Sentinels of Freedom? Yes No
Tell us about your Relationship:	characters left (250 characters or less)
Please print, complete and sign the Authorization for Disclosure of Information, which gives Sentinels of Freedom permission to contact your caseworkers and other advocates regarding your eligibility for the program. Fax the form to the Sentinels of Freedom Scholarship Foundation at 925.242.8900 once you've submitted your questionnaire. Your qualifications cannot be considered until the authorization form is received.
User agreement: "I understand that this form is used for qualification purposes only and does not serve as a formal application. Furthermore, I acknowledge that I am a member of the armed forces who was severely injured in the line of duty on or after Sept. 11, 2001.”