Please Complete this form for the Medal of Honor
The Law Enforcement Medal of Honor award is based upon the following criteria. We encourage you to provide several examples of the nominee’s outstanding service in any or all of the listed criteria.
The Law Enforcement Medal of Honor award - Circumstance(s) where employee, in line of duty, intelligently performs an act of extraordinary heroism or bravery involving personal injury or risk of imminent personal hazard of life, in direct combat or in saving or attempting to save or rescue the life of another with knowledge of the danger assumed, above and beyond that expected in the line of duty.
Fill out the form below. All fields with (*) are required.
If additional room is needed, please print this form and attach additional page(s) to this form.
Return this completed form as indicated on Instruction Page. Nominations will be considered and reviewed within 60 days of submission.