LOUDOUN CHAMBER
2025 VALOR AWARDS NOMINATION FORM
Deadline January 6, 2025

Please type or print neatly. Any attachments should not exceed 8.5” x 11”. The total nomination package should not exceed five pages of text (plus attachments), one-sided, on white paper. The awards will be made for acts that occurred between January 1, 2024 and December 31, 2024

Nomination Form for:

Individual(s)

Unit

Nominee/Unit Name(s):

Department (Police/Fire/Rescue/Etc.):

Rank of Nominee(s)

Home Address

City

State

Zip Code

Phone

Email

Nominee(s) Status: *

Volunteer

Paid Staff

Citizen

Other

Department Information (Company/Unit/Station)

Name of Commander/Chief:

Phone

Nominator's Name:

Mailing Address

City

State

Zip Code

Phone

Fax

Relationship to Nominee:

Nominee's Position (Rank/Dept)

Narrative Description of Act:

In order for the Selection Committee to determine significance of the nomination, please take sufficient time to create a very detailed description of the incident. Remember, the committee may be seeing this information for the first time and your description will be an important part of the selection process. The narrative should include, but not be limited to the following information:

Summary paragraph of the specific act (what the person(s) did to deserve recognition)
Date of the act (must fall between January 1, 2024 and December 31, 2024)
Time of day of the act
Location of the act (street address)
Other participants in the act (name, rank, unit, etc.)
Persons given aid (age, sex, address, type of aid, hospitalization, diagnosis, outcome)
Injuries to nominee(s) (treatment, hospitalization, diagnosis)
Equipment used at scene
Equipment used by nominee(s)
What specific dangers existed
List specifically what the nominee did
Describe the area/scene (entry, path of rescue, hazards, point of rescue, weather, etc.)
Other recognition received by nominee

Attachments: (must be 8.5” x 11”; total nomination cannot exceed five pages of text, plus attachments)

Recent photo of nominee(s) and/or group photo
Official department reports
Newspaper clippings
Videotape

Signature of Nominator: *

clear

The nominator understands that the Valor Awards Committee reserves the right to determine whether recognition will be presented and that he/she may be contacted if further information is needed. Questions regarding the Valor Awards should be directed to:

Paige Romanow, Loudoun County Chamber of Commerce, 571-209-9025

Return completed packets by mail, submission of form, email or hand deliver to: (once sent please follow-up with phone call to confirm receipt)

Paige Romanow, Events Manager
Loudoun County Chamber of Commerce
Address: 19301 Winmeade Dr, Ste 210, Lansdowne, VA 20176
Direct# 571-209-9025 / 703.777-1392 Fax
promanow@loudounchamber.org

NOTE: Nominations for the Valor Awards are for specific acts that occurred between January 1, 2024 and December 31, 2024. Any and all nominations received will be reviewed by the committee.

VALOR NOMINATION DEADLINE: January 6, 2025

LOUDOUN CHAMBER 2025 VALOR AWARDS NOMINATION FORM Deadline January 6, 2025

VALOR NOMINATION DEADLINE: January 6, 2025

LOUDOUN CHAMBER
2025 VALOR AWARDS NOMINATION FORM
Deadline January 6, 2025