1

Veterans Information

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Veterans Information

Veteran Name	Date of Birth	Telephone
Home Address	Email	Reason for Nomination

**Please send a Photo of Veteran** to Shawn.Rivers@racinecounty.com

2

Nominator’s Information

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Nominator’s Information

Nominator’s Name	Relation to Vet	Telephone
Home Address	Email

I have read the nomination guidelines and attest that the above information is accurate and true. If Racine County is unable to verify Veteran Status, we may request additional information. If selected as a “Veteran of the Month” I agree to allow Racine County to recognize nominated veteran by sharing this accomplishment via press release and social media channels.

3

Signatures

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Signature of Nominator

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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