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Award Nomination Form
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Name of person submitting nomination
Other (i.e. other city department, etc.)
Employee or EPD Officer name, rank and badge number if pertinent to the award
Shift on Duty
Stations that responded
Date of incident
Date of incident
Alarm number if applicable
Please list the names of all nominees
If a crew award please ensure all personnel that responded on the call are listed.
Please provide all pertinent contact information for civilian award nominees
Please provide a very detailed description of the incident and the actions taken to warrant the recognition
Please submit additional documentation (i.e. newspaper articles, letters, witness statements, etc.) to Awardscommittee@cityofelgin.org
Please cc' this form to the Staff Officers assigned to the shift on which the incident occurred.
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