Heroism Award Nomination

IDAHO DEPARTMENT OF CORRECTION
Heroism Award Nomination Form
Nominee's Name (First, MI, Last):
Position/Rank:
Location: --Select--
Award Criteria
Please select the appropriate award and criteria upon which this nomination is based.
F-Isillver Cross—The nominee displayed prompt or alert action that resulted in a life being saved
or the prevention of injury to others and he demonstrated exceptional care for other individuals.
Medal of Honor—While serving in an official capacity with the IDOC, the nominee displayed
exceptional bravery or heroism beyond the expectation of normal demand of correctional service and
he displayed great courage in the face of immediate danger.
Medal of Valor—For the nominee's loss of life or for sustaining a critical injury(or injuries) in the
line of duty.
Supporting Information
Date of the Incident:
Place where the incident occurred:
Describe in detail the incident prompting this nomination. Include what action(s)the nominee took that
demonstrated great courage and the danger he faced. As necessary, attach additional pages (in Word
document format with the nominee's and submitter's name clearly identified).
#of additional pages attached
Submitter's Name Signature Date
Division Chief's Name Signature Date
Director's (or board representative's) Name Signature Date
Appendix C . . .
128.00.01.001
(updated 10/17/14)