Nomination Form

Veterans Day Commemoration Program 2017
Honoree Nomination Form

Deadline for Nominations: Thursday, June 15, 2017

Name:

E-mail:

Phone:

Address:

Date of nomination:

Relationship to veteran:

Section 1: Nominee Information

Nominee name:

Has this person been nominated previously?

Nominee Address:
(Nominee must reside in Utah)

Nominee phone:

Nominee e-mail:

Branch(s) of service
(Nominee must be veteran of U.S. armed forces)

Section 2: Service Information

Dates of service:

Dates of combat duty:

Rank at end of service:

Medals awarded:
(Nominee’s DD214 and/or service record is required. Please upload, mail in, or deliver a copy of the nominee’s DD214 and/or service record to the Veteran’s Support Center.)

Unit, battalion, regiment, ship, wing, etc.:
(Please be specific)

1. Is the nominee willing and able to be interviewed about his/her war experiences?

2. Did the nominee experience combat or hazardous duty? If yes, describe.

3. Where did he/she serve and when? (i.e. In which war(s) and theater(s) did he/she serve?)

4. What is the age and health status of the nominee?

5. Has the nominee been publicly recognized in the past? If so, how?

6. Please tell us the story of this veteran's military experience in detail and why you think he/she is eligible for this recognition. Attachments are encouraged. The story you tell here will be used by the selection committee so please include as many details as possible.

How did you hear about us? Please mark all that apply.

Upload required supporting documentation.

Selected honorees will be invited to participate in a ceremony in their honor on Friday, November 10, 2017 at the University of Utah. If selected, documentation must be provided to verify service and awards.

You may also download a PDF version of the nomination form here.

  • University of Utah
  • 200 Central Campus Drive Room 418 SLC, UT 84112
  • 801-587-7722