Revised Lifesaving Award Nomination Form

  1. Review the Nomination Guidelines.
  2. The lifesaving incident must have occurred between June 1 of the prior year and May 31 of the current year.
  3. Nominations must be received no later than June 30 to be eligible for consideration this year.
  4. Submit the nomination:
    Complete the nomination online below, OR
    Print the  Application for Lifesaving Award, fill it out, and mail to the address on the application form.

The online form can be started and saved for completion later as needed. Required Photo Releases and photos of nominees can be submitted with the online form submission or provided later upon notification of acceptance of the nomination.

Lifesaving Award Nomination V2

Nominator

Please enter your information as the nominator for this Lifesaving Award.

Your Name(Required)
Your Address(Required)

Incident Description

Please provide the following information (refer to Guidelines 3-7).

MM slash DD slash YYYY
Approximate Time of Incident(Required)
:
Victim(s)
Click the + to add additional names
First Name
Last Name
Did they survive? (Yes/No)
 
Location of Incident(Required)
Include, in detail, what HANDS ON assistance/aid was provided to the victim by the nominee(s), to treat injuries sustained. For multiple nominees, describe what each person did.
Include the outcome of the rescue efforts.

Nominee Information

Enter each individual nominee covered by this submission
Name Actions
 

Photo Release

For print and promotional materials that include a nominee photo, nominees must complete and sign a photo release. Photo releases and photos must be received by the deadline stated in the guidelines. You may submit signed and scanned releases and upload photos with this submission, or the nominees may submit their release later.

Drop files here or
Accepted file types: pdf, doc, docx, Max. file size: 4 MB.

    Nominee Photos

    For a group of nominees, either individual photos or a group photo is acceptable.
    Minimum 450px wide by 600 px high.
    Drop files here or
    Accepted file types: jpg, jpeg, png, Max. file size: 12 MB.
      Minimum 1300 px wide by 600 px high.
      Drop files here or
      Accepted file types: jpg, jpeg, png, Max. file size: 12 MB.

        Additional Statements / Supporting Evidence

        Allowed file types: pdf | doc | docx | txt
        Drop files here or
        Accepted file types: pdf, doc, txt, docx, Max. file size: 3 MB.
          This field is for validation purposes and should be left unchanged.