<p> ILLINOIS VETERANS’ PATRIOTIC VOLUNTEER AND APPRECIATION AWARD Nomination Form</p><p>Please read the Nomination Guidelines prior to completing this form. Please attach the veteran’s up-to- date DD214 as well as a written summary of the nominee’s achievements following the guidelines.</p><p>______Nominee’s Name Date & Place of Birth</p><p>______Home Address, City & State, Zip Code</p><p>______Telephone (work & Cell) Email</p><p>______Location of Illinois Residency</p><p>______Nominator’s Name Relationship to Nominee (Comrade, relative, etc.)</p><p>______Home Address, City & State, Zip Code</p><p>______Telephone (Work & Cell) Email </p><p>I have read the nomination guidelines and attest that the above information is accurate and true. I also affirm, to the best of my knowledge that the nominee stated above is in good legal standing.</p><p>Signature of Nominator ______Date: ______(Required)</p><p>I have read the nomination guidelines and attest that the above information is accurate and true. If selected as a recipient of the Illinois Veterans’ Patriotic Volunteer and Appreciation Award, I agree to attend a public appearance with the Illinois Department of Veterans’ Affairs; and, I agree to participate in all media and outreach efforts and activities.</p><p>Signature of Nominee ______Date: ______(Required)</p><p>SEND COMPLETED FORM TO: [email protected] (email) or to mailing address below: Illinois Department of Veterans’ Affairs Attn: Illinois Veterans’ Patriotic Volunteer Appreciation Award 100 West Randolph St., Suite 5-570 Chicago, IL 60601-3219 ILLINOIS VETERANS’ PATRIOTIC VOLUNTEER AND APPRECIATION AWARD Nominating Service and Achievements (Be sure you have read the Nomination Guidelines prior to completing this form.)</p><p>Date Summary of Achievements/Accomplishments/Awards</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>Use the section below to describe and provide more details: Summary of Achievements/Accomplishments/Awards Details Continued……..</p><p>Please attach documentation(s) that will substantiate the nominee’s service and accomplishments described above (i.e., news articles, relevant online biographies and/or copies of commendations, etc.).</p>