Applicant Information

Thank you for nominating your department for the LIFE Award! Click here for more details.  

Please fill out the following form in its entirety. All departments submitting nomination forms must have had their program up and running for at least one year.

Departments can not be selected to win more than 2 times in a 5-year period.

All forms MUST be submitted by Friday, August 24, 2018

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* 1. Agency being nominated:

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* 2. Nominator's name and title:

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* 3. Contact Address: provide address, city, zip.

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* 4. Phone:

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* 5. Fax:

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* 6. E-mail:

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* 7. Date of implementation of wellness/fitness program or project: *minimum 1 year prior to nomination

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* 8. Category applying for

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* 9. Total number of personnel:

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* 10. Number of full-time:

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* 11. Number of part-time:

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* 12. Number of reserve:

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* 13. Number of volunteer:

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* 14. Name of Fire Chief or Executive Officer

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* 15. Fire Chief or Executive Officer phone number:

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* 16. Fire Chief or Executive Officer email:

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