The NJ Police Chief Magazine - Volume 31, Number 5 | Page 14

CONTACT INFORMATION FOR PERSON SUBMITTING NOMINATION FORM :
Name :
Department / Agency / Organization :
Address :
City / State / Zip :
Phone : E-mail :
Relationship to Nominee :
NOMINEE INFORMATION :
Name :
Title / Rank :
Department :
Address :
City / State / Zip :
Date ( s ) of Exceptional Act ( s ):
1 .
Please give a brief history of the nominee .
2 .
Describe the event or circumstance for which you feel the nominee displayed unparalleled courage and valor and is deserving of the New Jersey
Police Chiefs Foundation Valor Award .
3 .
Describe in detail why you feel the nominee went above and beyond the call of duty during this event .
IMPORTANT DETAILS :
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Answers to questions 1-3 should be typed on separate 8 1 / 2 x 11 pages and attached to the nomination form .
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The incident / meritorious act described in this nomination form must have occurred between January 1st and December 31st
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The award is open to all law enforcement officers in the State , regardless of rank .
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The recipient of the award may be living or deceased .
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The recipient will receive a medal at the NJSACOP Annual Conference held in June in Atlantic City , New Jersey .
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Nomination forms will be published in The New Jersey Police Chief Magazine and on the NJSACOP website .
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Incomplete nomination forms will not be considered .
Signature : ___________________________________________________________________________ Date : _______________________________
Please send nomination forms to :
New Jersey Police Chiefs Foundation Valor Awards Program 751 Route 73North Suite 12 Marlton , New Jersey08053 office @ njsacop . org