Benjamin F. Dillingham, III & Bridget Wilson LGBT Veterans Wall of Honor Nomination Form

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Please submit this form and all backup information by Saturday, July 31, 2021 for induction consideration this year.

Email *

This section is for information about the person being nominated.

Nominee's Full Name *

Branch of Service *

U.S. Army

U.S. Marine Corps

U.S. Navy

U.S. Air Force

U.S. Coast Guard

Years in service *

For example: 1975-1979

Type of discharge *

Time lived in or served in San Diego *

Best description of ethnic identity *

Best description of gender identity *

Best description of sexual orientation *

Pronouns *

For example: she/her/hers, they/them/theirs

Is candidate living or deceased? *

Living

Deceased

Candidate phone number *

If they are deceased mark n/a.

Candidate e-mail address *

If they are deceased mark n/a.

This next section is asking information about the person submitting this nomination form.

Name of nominating individual *

Relationship to nominee

Partner/Spouse

Friend

Sibling

Co-Worker

Other:

Clear selection

Your phone number *

Please describe how the nominee meets the nomination requirements (which are listed here: https://thecentersd.org/candidate-criteria/). Please write this section as if the committee knows nothing about the candidate, and use detail to describe the candidate's contributions to the community. If desired, you may type the response to this section in a separate word processor like Word and paste it here.

Please list two additional San Diego County residents who will serve as co-sponsors of this application including: full name, phone number, and email. *

Nomination check-list

Items that are separate from this online application (ie. nomination statement, DD214, etc) should be sent in separately by July 31, 2021 via e-mail to hweldeghiorgis@thecentersd.org or post mail to:
The Center
c/o Helen Weldeghiorgis
PO Box 3357
San Diego, CA 92163

Please check-off items you have completed/submitted. *

This completed nomination form

Nomination statement (as part of this nomination form)

E-signatures of 2 co-sponsors. Find the form here: https://forms.gle/WrsxWShcybGUMnVF6

Form DD214 (or equivalent). Please not that only the veteran or the veteran's first of kin can get copies of a service member's DD-214 AND that it could take up to a month to receive one. They can be obtained at: http://www.archives.gov/veterans/military-service-records/

Other:

Required

If you are not submitting any piece of the required documentation from the nomination check-list, please note the reason below.

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

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