ULSTER COUNTY EMERGENCY SERVICE RECOGNITION PROGRAM

Nomination Form

Agency *

Nominee's Name *

Nominee's Home Address *

Postal Community

State

Zip

Phone

Date of Incident *

Year

Month

Day

Location *

Description of Actions *

Award (check one)

Heroism Award – Eligible candidate is an emergency service provider who distinguishes themselves by exhibiting bravery, heroism, or other outstanding action under extreme conditions, extraordinary circumstances, or while in great danger.

Lifesaving Award – Eligible candidate is an emergency service provider who makes a noteworthy or exceptional contribution to efforts which result in the saving of a life.

Meritorious Service Award – Eligible candidate is an emergency service provider who performs an exceptional act, above and beyond the call of duty, in the course of a particular emergency event, and performs in a commendable manner.

Distinguished Service Award – Eligible candidate is an emergency service provider who performs distinguished service through a commitment to providing leadership, education, or public awareness to the emergency services in general, their department or agency, or the community they serve over an extended period of time.

Length of Service Award – Eligible candidate is an emergency service provider who has served their community for an extended period of time.

Unit Citation – Eligible candidate is an emergency service agency, department or unit that distinguishes itself by exceptional service in the performance of duty that is clearly above and beyond that which is normally expected, thus bringing credit to the agency, department or unit.

Youth Member Award – Eligible candidate is a youth member (junior member, Explorer scout, etc.) of an emergency service organization who has exemplified dedication, responsibility and professional behavior in service to their community.

Citizen’s Award – Eligible candidate is a member of the community that took extraordinary action to assist an emergency service provider, or agency, that was clearly above and beyond that which would normally be expected.

Submitted by *

Submitter Agency

Rank of Title

Phone

Email Address *

Instructions:
- Nomination period is from September 1 of one year to the same date the following year. - Nominations must be received by September 1.Ulster County Emergency Services Volunteer Program

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ULSTER COUNTY EMERGENCY SERVICE RECOGNITION PROGRAM

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