2023 Valor Nomination Form

2023 Valor Nomination Form
Since 1980 the 100 Club has given The Hundred Club Valor Award to sworn Police Officers, Firefighters, and EMS Professionals. Awards are presented to those who have performed actions above and beyond the call of duty.

We will review nominations submitted by January 31, 2024 for any actions taken between January 1 and December 31, 2023. All Police Officers, Firefighters, and EMS Professionals in Illinois are eligible. Command staff should submit all nominations by completing the below form no later than January 31, 2024 at 5:00pm. Questions or submissions may be sent to:

Kaira Zaremba
Program Manager, 100 Club of Illinois
Attn: Valor Award Nomination
kzaremba@100clubil.org

Once nominations are received, representatives from various departments and associations will select an award recipient from your area. All award recipients and their families will be invited to attend one of the regional Valor Award receptions located throughout Illinois. Should your nominee be chosen, we will ask a representative from your department to assist in presenting the award at the ceremony.

If you have any questions, please contact Kaira at kzaremba@100clubil.org.
Nominee Information
Nominee Name

First NameLast Name
Nominee Phone Number
Please enter a valid phone number.
Nominee E-mail Address
example@example.com
Nominee Department
Nominee Rank
Years at Department
Date of Incident

MonthDayYear
Date
Previous Award Recognition: In the space below, please state any prior awards the nominee(s) have received for the incident.
Commanding Officer Information
Commanding Officer Name

First NameLast Name
Commanding Officer Email
example@example.com
Commanding Officer Phone Number
Please enter a valid phone number.
Incident Details

In the space below please provide a description of the incident which the nominee(s) are being honored for, or indicated that a separate document with a description of the incident and upload below. Descriptions shared in this nomination will be read as-is at the valor awards ceremony.
Incident Description
Additional Documentation or Incident Description Upload

Cancelof
Submission Contact Information
Is the person completing this submission the Commanding Officer listed above?

YesNo
Submittee Name

First NameLast Name
Submittee Email Address
example@example.com
Submittee Phone Number
Please enter a valid phone number.
Should be Empty:

2023 Valor Nomination Form

Nominee Information

Commanding Officer Information

Incident Details

Submission Contact Information