VFW Department Public Servant Award Citation Request Form

VFW Department Public Servant Award Citation Request Form

Department of _____________________, VFW

(State)

Date of presentation: ___________________________

(Month, day, year)

Sponsoring Post #__________ Sponsoring District #__________

Choose appropriate citation: ______________________________

(EMT / Firefighter / Law Enforcement)

Nominee information:

Name of Nominee: _______________________________________

Gender: __________________________

(Male / Female

Title (if any): ________________________________________

Employer Name: ______________________________________________

Address of Employer: _____________________________________

City, State Zip Code: __________________________________________

Employer Phone #_______________________________

Approved by _________________________________________________

(Department Commander, Department Adjutant or Department Safety Chairman)

Please complete this form and forward it to VFW National Headquarters, Programs Department, 406 W. 34th Street, Kansas City, MO 64111, by February 1st or three weeks prior to the presentation date. The appropriate citation will be forwarded to your Department Headquarters for presentation. If you have any questions, please feel free to contact Tammy Beauchamp at 816-756-3390 x287, e-mail tbeauchamp@vfw.org or Steve Van Buskirk at 816-968-1116, e-mail svanbuskirk@vfw.org