Wounded Warrior Big Game License(s) Program Application

Physician's Signature & Date

Colorado Parks And Wildlife, Attn: Wounded Warrior Program, 6060 Broadway, Denver, CO 80216

Mail completed application to:

"I certify that the patient listed on this application (applicant) is

currently under my care and I am fully aware of the patient's

medical condition. Furthermore, I certify that the applicant is a

member of the United States Armed Forces and is a resident of, or

stationed in, Colorado returning from post-September 11, 2001

overseas contingency operations. Additionally, I certify that the

applicant is so severly injured during combat, or combat-related

support activities that the applicant will require years of intense,

ongoing care or assistance. I also certify that the applicant is

currently assigned to a military medical treatment facility and is a

member of the United States Armed Services Wounded Warrior

program (as defined on the reverse of this application). I

understand that providing false information when completing this

application is a criminal offense."

Physician’s Name, Address, & Phone Number

Please Print or Stamp Clearly

Applicant's Signature & Date

Address Release Box: By checking this box, I give the Colorado Parks And Wildlife

permission to forward my name, address, phone number, & license information to

certain persons requesting it. (see Big Game Brochure for further details)

Physican's Statement

This program will assist the applicant in acquiring a Big Game license for deer, elk, and/or pronghorn.

HeightWeight

List Month & Year if CO resident

Social Security #

Required if not on record

List 'Military' if stationed in CO

Colorado Resident Since

Hunter Education # & State of issue

Required if born on or after Jan 01, 1949.

Military Training does NOT qualify for Hunter Education.

Area Code & Phone Number

Driver's License # & State

Date of Birth (mm-dd-yyyy)MIFirst Name

Zip Code

State

City

Mailing Address

Sex

Customer Identification Number (CID)

Last Name

If you do not have a CID #, please leave blank

A R

D R

Pronghorn

"I certify that the information given on this application is true and accurate. I certify that I am a member of the United States Armed

Forces, who is a resident of, or stationed in, Colorado returning from post-September 11, 2001 overseas contingency operations and I

have been so severely injured during combat, including combat-related support activities that I will require years of intense, ongoing

care or assistance. Additionally, I certify that I am currently assigned to a military medical treatment facility and I am a member of a

United States Armed Services Wounded Warrior program (as defined on the reverse of this application). I hereby authorize the

Colorado Parks And Wildlife to make further inquires to verify this information which may include contacting my physician, therapist,

or my Commanding Officer. I understand that providing false information when completing this application is a criminal offense and I

specifically agree that venue for such offenses shall be the District and County Court of Adams County Colorado unless otherwise

agreed by the Colorado Parks And Wildlife."

Application for the Wounded Warrior Big Game License(s) Program

Please print clearly in all CAPITAL letters Huntcode Choice(s):

E R Elk

Deer

Colorado Parks And Wildlife Regulations: Chapter 2, Article 1, #206, B, 4, f:

Wounded Warr

ior Hunting Licenses – The Director may make certain deer, elk, and pronghorn licenses

available to qualified participants in any United States Armed Services Wounded Warrior programs.

1. Applicants must be members of the United States Armed Forces, who are residents of, or stationed in,

Colorado returning from post-September 11, 2001 overseas contingency operations who have been so

severely injured during combat, including combat-related support activities, that they will require

years of intense, ongoing care or assistance. Additionally, applicants must be members of a United

States Armed Services Wounded Warrior program, as defined in 33-4-102(1.9) C.R.S., and must be

assigned to a military medical treatment facility at the time of application for this program.

2. Applications shall contain a statement from a license medical doctor certifying the applicant’s

eligibility under the criteria in 1 above. Additional documentation may be required if necessary to

establish the applicant’s eligibility under this program.

3. Applications for antlerless deer and elk and doe pronghorn licenses shall be made on the form

available from the Colorado Parks And Wildlife, Limited License Office, 6060 Broadway, Denver, CO.

Applications for antlered deer and elk and pronghorn buck licenses shall be made on the form

available from the applicable Colorado Parks And Wildlife regional service center. Hunters may apply

from the Monday after the May Commission meeting through the last day of the rifle seasons. Licenses

issued under this program shall be issued as free licenses.

4. Antlerless deer and elk and doe pronghorn licenses will be available in all game management units

with a total allocation of more than 100 antlerless deer or 100 antlerless elk or 50 doe pronghorn

during the rifle seasons described in 250, 257, and 262 of these regulations. For any one game

management unit no more than 10 licenses or 2 percent of the total number of limited antlerless deer

or elk or doe pronghorn licenses for the game management unit, whichever number is greater, shall be

issued as Wounded Warrior hunting licenses for the species in question.

5. Antlered or either-sex licenses for deer or elk and buck pronghorn licenses will be private land only

licenses and will be available for hunt codes requiring four or fewer resident preference points to

draw in the previous year in all game management units with a total allocation of more than 100

antlered or either-sex deer, 100 antlered or either-sex elk, or 50 buck pronghorn during the rifles

seasons described in #250, #257, and #262 of these regulations. For any one game management unit

no more than 5 licenses or 2 percent of the total number of limited antlered, either-sex or buck

licenses for the game management unit, whichever is greater, shall be issued as Wounded Warrior

hunting licenses for the species in question.

6. Antlered or either-sex licenses for deer or elk and buck pronghorn licenses will be approved by the

applicable Regional Manager on a case-by-case basis for hunters who qualify under this program in

instances where an organization assisting Wounded Warrior hunters has coordinated a hunting

opportunity specifically for this program and where all other avenues of obtaining a license have been

exhausted.

7. Wounded Warrior hunting licenses will be valid only for the season dates and any units included in

the authorized hunt code. Wounded Warrior hunting licenses may not be issued for Ranching for

Wildlife properties unless otherwise provided in the ranch contract.

Definit

ion of United States Armed Services Wounded Warrior Program as stated in the Colorado Revised

Statutes §33-4-102 (1.9) for the purpose of the Colorado Parks And Wildlife Wounded

Warrior Hunting Program:

“United

States Armed Services Wounded Warrior Programs” means:

(I) The Army Wounded Warrior (AW2) Program;

I) The Air Force Wounded Warrior (AFW2) Program;

(III) The Navy Safe Harbor Program;

(IV

) The Coast Guard Wounded Warrior Regiment; And

(V) Any successor program administered by a branch of the United States Armed Services to

provide individualized support for the service members who have been severely injured

in overseas contingency operations undertaken since September 11, 2001.

Revised 05/2012