FLORIDA STATE FRATERNAL ORDER OF POLICE - Tallahassee, FL

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GOVERNOR'S MEDAL OF HEROISM NOMINATIONS

Pursuant to Florida State Statute Section 112.194

You may submit this nomination electronically or print this page and snail mail to the address below. A 500 word or less synopsis should accompany this nomination.

Criteria for Nomination: (Must Meet All Four Components)

1. Nominee must have risked his/her life.
2. Nominee must have known there was perilous risk.
3. Nominee performed in the capacity of his/her position.
4. Nominee's actions were for the express purpose of saving a life.

To mail your nomination use the address below:
Medal of Heroism Selection Committee
PO Box 1349
Tallahassee, FL 32302


   
Last Name First Name Middle
     
Street Address City State
     
Zip Code Email Address  
 
     
Maritial Status Date of Birth  
/ /  
     

Agency Employed By  
Position Held  
Agency Size
(Number of Certified Personnel)
 
Agency Head  
 
Length of Time Employed by Agency
1 - 2 yrs 3 - 5 yrs > 5 yrs
 
Address City State
 
Zip Code Agency Phone  
 
 
 
Other Public Safety Experience (optional)
 
500 word or less summary why nominate
 
Required Field
Star and Shield Marist