Plaque Application

Plaque Application (Sponsored by Til Valhalla Project)
You will need to know several pieces of information to complete this form.

1.) Hero's Branch, Rank, Name, DoB, and DoD.
2.) Hero's marital status, number of children, etc.
3.) Next of Kin information.
4.) Verified address for the Next of Kin.
5.) Photo(s) of the Hero in uniform.
6.) Obituary links, links to the Hero's story, and links to articles about the Hero.

IF YOU DO NOT HAVE ALL OF THIS INFORMATION, PLEASE SEND THIS FORM TO SOMEONE WHO CAN ANSWER THESE QUESTIONS WITH 100% ACCURACY!

Read this disclaimer FULLY before filling out the application for a Memorial Plaque.

Every plaque we produce holds a special significance as it is presented to the Next of Kin of a Fallen Hero. Our intention is to honor and commemorate all Fallen Heroes. While we empathize with the desire to provide multiple plaques to their families, we face certain limitations that prevent us from doing so. Therefore, we strive to ensure that each Fallen Hero is honored with a single plaque, symbolizing their sacrifice and our deep respect for their service. We wish we could create multiple Memorial Plaques for every family; unfortunately, it is not possible if we want to uphold our mission of honoring all Fallen Heroes.

Failure to submit the application for the Next of Kin, unfortunately, results in the denial of the Plaque request. Submitting the application with the proper information is a vital step in our process to maintain accuracy, accountability, and fairness. Only by providing the required documentation and information can we effectively verify and validate the request. Our utmost responsibility is to uphold the integrity of our Mission to properly Honor Fallen Heroes. We strongly urge individuals to complete the application with comprehensive details to increase the likelihood of approval and fulfillment of the Plaque request.

Your Relationship to the Fallen Hero & Family
What is your relationship to the Fallen Hero?*
What is your relationship to the recipient of the plaque (not the Hero)?*
Other: Please explain your relationship to the Recipient*
Will you be hand delivering this plaque to the Next of Kin?*

YesNoI am the Next of Kin
Great! Continue filling out the form so we can get started honoring your Hero. Please input your mailing address in the following fields.
Not a problem! We will find someone to deliver it for you! Continue filling out the form so we can get started honoring your Hero.
You have our deepest condolences for your loss. Continue filling out the form so we can get started honoring your Hero.
Your First & Last Name
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Thank you! We offer one #LEGACYGUARDIAN shirt per application so you can wear it during the delivery. What size shirt would you like?*
Please keep in mind, these are unisex tees only
About your Fallen Hero
How did this Hero serve?*
What is the last confirmed rank on this Hero? (ARMY)*
What is the last confirmed rank of this Hero? (MARINE CORPS)*
What is the last confirmed rank of this Hero? (NAVY)*
What is the last confirmed rank of this Hero? (AIR FORCE)*
What is the last confirmed rank of this Hero? (COAST GUARD)*
What is the last confirmed rank of this Hero? (ARMY NATIONAL GUARD)*
What is the last confirmed rank and department of this Hero? (LAW ENFORCEMENT)*
What is the last confirmed rank of this Hero? (EMT)*
What is the last confirmed rank of this Hero? (FIREFIGHTER)*
What is the Hero's first name, middle initial, and last name?*
Heroes Date of Birth*

MonthDayYear
Heroes Date of Passing*

MonthDayYear
How did your Hero pass?*
Please upload several high quality images of just the Hero in uniform (these will be used for the plaque).*

Cancelof
Are you able to link an Obituary or do you have a physical copy?*

Attach Link to ObituaryUpload Physical Copy of Obituary
Please provide a link to the Fallen Hero's obituary or any website that fact checks the Heroes rank, spelling, branch, etc.*
Please upload a copy of the Fallen Hero's Obituary*

Cancelof
Additional Link
Tell us about the service of your fallen Hero. *

Please do not copy information from the Obituary.0/1500
What is this Hero's marital status at the time of passing?*

MarriedSingleWidowedWidower
How many children does the Hero have? (Used to know how many bands to include with the package).*
Are the parents of the Hero with us? (Used for determining if we need to include additional items with the package).*

TogetherSeparatedOne parent deceasedBoth parents deceasedOther
About the Next of Kin
Who is the Next of Kin (NOK) for this Hero?*

SpouseChildrenGrandchildrenParent(s)Sibling(s)Grandparent(s)Other
What is the name of this Hero's Next of Kin?*
What is the mailing address for this Hero's Next of Kin?*

Street Address

Street Address Line 2

CityState

Zip Code
Your Contact Information
Your Full Name*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
If we can't reach you, who else can we call?*
Phone Number for additional contact*
Please enter a valid phone number.
Preferred Contact Method*
Notice: If there is an issue with the information submitted on the plaque application (Next of Kin, Photo, Address, etc.) and we cannot get a hold of you (after 30-days of contact attempts), we will unfortunately, have to deny the request for a Memorial Plaque and your application will be archived.*

I Understand
Note: Please know that we generally wait (at least) a year after a Fallen Hero has passed before creating their memorial plaque.*

I Understand
A lot of people forget about this form and lose the opportunity because we cannot reach them.

Be different - take the time and save our number (904) 579-3422 as "Til Valhalla Project" into your phone right now so you know it's us if/when we call. In addition to our phone number, please also whitelist our email address fallenheroteam@tilvalhallaproject.com, to ensure none of the emails in regard to this application get sent to spam.
Last Step!
Please tell us more about how the Hero served; whether in the military and/or as a first responder. You can also share how their legacy lives on through their family and community.*

Please do not copy information from the Obituary.0/0
Should be Empty:

Read this disclaimer FULLY before filling out the application for a Memorial Plaque.

Your Relationship to the Fallen Hero & Family

About your Fallen Hero

About the Next of Kin

Your Contact Information

Last Step!