Nomination Form - Florida Department Of Veterans' Affairs printable pdf download

Nomination Form - Florida Department Of Veterans' Affairs

NOMINATION FORM – 2017

Be sure to read the Nomination Guidelines prior to completing this form.

All nominations must be received no later than May 31, 2017

Nominee’s Full Name__________________________________Email Address__________________________

Home Address______________________________________________________________________________

Nominee’s City______________________________________State______________ZipCode______________

Telephone No._____________________________Mobile/Cell No.____________________________________

Nominee was born in FL: Yes No. If No, the number of years Nominee lived in Florida:____________Years.

(Please circle Yes or No)

Did Nominee Receive an Honorable Discharge from the Armed Forces? Attached

Yes

verification of Honorable Discharge.

Nominee’s Date of Birth_______________________Is Nominee Deceased?

Yes

Please attach to this nomination form a typed summary of the nominee’s achievements and contributions as outlined

in the Nomination Guidelines. Include copies of Military discharge papers and any other supporting documentation.

Note: The nomination packet may not exceed ten (10) pages. Printing must be font size 12pt or larger. Any

packet which does not comply will not be considered and will be returned. Also, letters simply recommending

your nominee will not be considered. Multiple nominations for the same nominee are discouraged.

NOMINATOR’S STATEMENT: I hereby affirm the information contained herein is accurate to the best of my

knowledge and understanding, and in conformation with the Nomination Guidelines. I agree to provide additional

information if required by the Florida Veterans’ Hall of Fame.

Nominator’s Name______________________________Relationship to Nominee________________________

(Refer to Nomination Guidelines)

Telephone Number______________________________Email Address________________________________

Nominator’s Signature (Required)_______________________________________Date___________________

Please Note: Only the nominator will be notified if this nomination is NOT Selected.

Mail or Email this form and completed packet to:

(

FVHOF@FDVA.STATE.FL.US

)

Florida Department of Veterans’ Affairs

Attention: Veterans’ Hall of Fame

The Capitol, Suite 2105

400 South Monroe Street

Tallahassee, FL 32399-0001

Nomination Form - Florida Department Of Veterans' Affairs