Henry County Valor Awards - Public Safety Nomination Form

Henry County Valor Awards - Public Safety Nomination Form

Please complete the following nomination form for your public safety award nominee(s). The deadline to submit your nomination is Monday, August 31. An independent selection committee reviews nominations, and award recipients will be announced at the 2026 Henry County Valor Awards Luncheon on Friday, November 13, 2026.
**Nominees must be employed by or officially affiliated with a qualifying public safety, healthcare, or public health organization located in Henry County, Georgia. Individuals employed outside Henry County are not eligible.
Nominator Information

Please enter the information indicated below.
Your First Name
Your Last Name
Your Company Name
Email Address (Nominator)
example@example.com
Nominee Information
Nominee or Unit Name
Nominee Title/Rank/Department
Nominee Employer/Agency
Email Address (Nominee)
example@example.com
Phone Number (Nominee)
Please enter a valid phone number.Format: (000) 000-0000.
Total Years of Service Within Public Safety
Years of Service With Department
Chief
Supervisor Name/Email/Phone
Please Select the Award for Which You are Nominating this Individual.
Date of Occurrence (Events must have occurred between July 1, 2025 and June 30, 2026 to be recognized.)

MonthDayYear
Date
Time of Occurrence
Occurrence Description
Upload any relevant documents supporting the nomination. (Ex. photos, articles, references, etc.)

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Nominator Information