2. Citizen Leadership Award Nomination Form
   The Loudoun County Sheriff's Office is seeking nominations from the public for the 3rd Annual Citizen Leadership Award.
4. Your Name (Nominator)*
5. Email of Nominator*
7. Name of Nominee*
8. Phone of Nominee*
9. Email of Nominee
11. Address of Nominee
13. Address2
15. City
16. State
17. Zip
19. Criteria
    • Candidate participates in activities that make a difference in the well-being of others
    • Candidate has exceptional ethical qualities and strives to improve and preserve the community
    • Candidate has shown support for the community over a period of time
21. Narrative: In 250 words or less, please describe how the nominee meets the criteria:*
Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field