2024 Valor Nomination Form

2024 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 15, 2025 for any actions taken between January 1 and December 31, 2024. 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 15 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

Please submit the following information of the person being nominated for this award
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 at the time of incident*
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

Please submit the following information of the nominee's Commanding Officer
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 Award ceremony.
Incident description as it should be read if selected for the Valor Award ceremony:*
Additional Documentation or Incident Description Upload

Cancelof
Submission Contact Information

Please submit the following information of the person submitting this nomination
Is the person completing this submission the Commanding Officer listed above?*

YesNo
If you are not the Commanding Officer, please complete your information below so we can contact you if questions arise during the review process.
Submittee (Your) Name

First NameLast Name
Submittee (Your) Email Address
example@example.com
Submittee (Your) Phone Number
Please enter a valid phone number.
Submittee (Your) Department
Submittee (Your) Role/Title
Should be Empty:

2024 Valor Nomination Form

Nominee Information

Commanding Officer Information

Incident Details

Submission Contact Information