2019 CT100 Awards Nomination Form

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This form is used to nominate First Responders for exceptional achievement, as well as lifetime service, in any police, firefighting or emergency medical endeavor. Nominations should be someone who represents your department/agency with honor and extols the highest standards within the community. All First Responders covered by the Chisholm Trail 100 Club are eligible to win these awards. Nominations are put forward by peers and then reviewed by an Awards Committee. Awards are not intended to be given every year, and may not be awarded even if nominations have been made.

Email *

Nominating Agency *

What Department are you associated with?

Nominator's Name: *

Nominator's Work Phone: *

Nominator's Email Address: *

Type of Award *

Which award are you nominating someone for?

Chisholm Trail 100 Club Award - for outstanding bravery in the line of duty. The nominee has gone above and beyond the call of duty and done something extraordinary.

Lifetime Achievement Award - for a first responder who has served for at least 20 years in Johnson, Somervell and/or Hood county or in the city of Mansfield.

Nominee's Name *

Include rank, first name, last name

Do you have a photo of the nominee that can be submitted if they are chosen as a recipient? *

Yes

Nominee's Supervisor *

Nominee's Supervisor Phone Number *

Please provide information regarding the incident/service for which the individual is being nominated: *

If you need additional space you can email cara@ct100.org to continue. You can also submit links to news story or other items via email.

A copy of your responses will be emailed to the address you provided.

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