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Law Enforcement Purple Heart Nomination Form

Please Complete this form for the Law Enforcement Purple Heart


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brown bulletpointLaw Enforcement Purple Heart


The Law Enforcement Purple Heart 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 Purple Heart award is an award for an employee due to injury or death sustained during the normal performance of job or action due to confrontation with a criminal and not due to accidental death or injury.    


Law Enforcement Purple Heart Nomination Form

Fill out the form below. All fields with (*) are required.

* Date of Nomination :
* Nominee (if known) :
* Nominator:
* Nominator email:
* Nominator Phone:
* Give detailed description of event and how your nominee performed
        to deserve this award.
Attach additional pages if necessary:


Please complete and mail this form to the Sheriff's Office.




If additional room is needed, please 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.


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