Medal of Merit Special Recognition

Medal of Merit Special Recognition

The Indiana Department of Homeland Security recognizes individuals for exceptional conduct and the performance of outstanding services to Hoosiers to support the safety, security and resilience of Indiana. Complete this form to nominate someone for the Indiana Homeland Medal of Merit.

Nominee's Name*

Nominee's Job Title or Position

Nominee's Primary Agency or Organization (if applicable)

Nominee's County

Select all that apply.

Select

Nominee's Years of Service (if known)

Nominee's PSID Number (if applicable, known)

The PSID number is a public safety worker's unique identifying number.

Your Title*

Example: Fire Chief, Fire Marshal

Your Relationship to Nominee*

Your Name*

Your Email Address*

Your Phone Number*

Description of Nomination*

Use this field to describe why you are nominating the recipient. If the description is lengthy, please use the following File Upload section to attach a file containing the full description and any supporting documentation.

File Upload (optional)

Upload supporting documentation, such as recommendation or testimonial letters, photos, eyewitness accounts, maps, etc.

Drag and drop files here or

Recognition Requested by the Following Date (optional)

Please provide at least 2 weeks' notice.

Recognition Requested to Be Presented In Person

Select

Details of In-Person Presentation

If requesting an in-person presentation, please describe the event or gathering (if applicable), including time, date and place. Please provide at least 2 weeks' notice of in-person presentation requests.

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