2. LIFE SAVER'S AWARD NOMINATION APPLICATION - FISCAL YEAR 2022
4. Local Government Insurance Trust is offering a Life Saver’s Award. The award is presented to a person directly responsible for saving a human life. This person must be a LGIT member’s employee or an individual who saves the life of a LGIT member’s employee.
6. Name of Local Government*
8. Submission Deadline:
   August 19, 2022
9. Award Date:
   Recognized at LGIT's Annual Meeting in Novermber.
11. Contact First Name*
12. Contact Last Name*
13. Title*
15. Address*
17. Email*
18. Phone Number*
20. Name of Nominee*
22. Title*
23. Department*
25. Brief description of life saving action.*
27. Why you believe this person should be recognized for this award.*
29. Additional Comments
31. IMPORTANT
    Complete within 60 days of incident. Attach police reports, photos, etc.
33. Upload Supporting Documentation (single pdf)
35. For further information regarding LGIT Grant Programs, please contact:
    Larry Bohlen, Director of Field Services at 443.561.1700 or lbohlen@lgit.org.
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit Submit and Print

* indicates a required field