Kentucky Peace Officers Association Peace Officer of the Year by selfesteem

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									                            Kentucky Peace Officers’ Association
                         Peace Officer of the Year Nomination Form

Please print or type.
Rank and Full Legal Name of Nominee______________________________________________

Department or Agency___________________________________________________________

Address of Nominee_____________________________________________________________

Home Phone__________________________ Office Phone______________________________

Reason for Nomination (You may attach a narrative if additional space is needed.)




   _______________________________                              _______________________________
        Print or type Name of Nominator                              Signature of Nominator


Note: Nominations without photo will not be considered. A photo of the nominee must be included
unless nominee is an undercover officer and agency or department requests that photo not be used. The
photo of the winner will be used in the conference program and in On Guard newspaper. There will not be
time to submit photo after selection is made. An online nomination form is available at
http://www.kpoa.info/nomination.htm

Mail form and photo to be received by 5:00 p.m., E.D.T., July 31, to:
                                              KPOA, Inc.
                                              P.O. Box57
                                         Lexington, KY 40588

								
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