K9 Medal of Courage Nominations Form

This Nomination and Release Form (“Nomination Form”) MUST be completed and signed to enter. By submitting this Nomination Form, you acknowledge that you have read, or have had read to you, understand and agree to comply with all terms and conditions contained in the American Humane Lois Pope LIFE K-9 Medal of Courage Awards Official Rules (the “Official Rules”).

To be eligible to receive the American Humane Lois Pope LIFE K-9 Medal of Courage Awards, the nominated dog must have appropriate credentials as a retired Military Working Dog (MWD) or Contract Working Dog (CWD) and Sponsor has the right to request, require and verify the narrative story and credentials at any time. Each nominated dog must have served in a forward-deployed combat operation outside the U.S., be retired from MWD/CWD service, living at the time of nomination, and currently be located within the United States. Sponsor has the right, in its sole discretion, to disqualify any nominated dog that does not have satisfactory credentials and/or whose narrative story cannot be verified in Sponsor’s sole opinion. Nominated dogs must not be currently used in connection with a for-profit business owned or run by the owner or handler of the dog.
Dog's Name*
Dog's Age
(approximate if not known)
Dog's Gender

MaleFemale
Breed
(if known)
Year's of Service
(if known)
Nominating Party's Information
Your Name*

First NameLast Name
Over 18 years of age?*

YesNo
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
E-mail*
Are you the owner/handler of the nominated dog?*

YesNo
Owner's Name

First NameLast Name
Over 18 years of age?

YesNo
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Enter Owner/Handler's email
Please NOTE: The owner/handler will be required to sign an Affidavit of Eligibility, Liability and Publicity Release prior to his/her dog being awarded the American Humane Lois Pope LIFE K-9 Medal of Courage.
Credentials
PLEASE ATTACH A COPY OF YOUR DOG’S CREDENTIALS/IDENTIFICATION AS DESCRIBED BELOW.

The nominated dog must have appropriate credentials as a retired Military Working Dog (MWD) or Contract Working Dog (CWD). Each nominated dog must have served in a forward-deployed combat operation outside the U.S. and be retired from MWD/CWD service.
Upload Credential*

Browse Files

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Credentialing Organization*
Year of Credentialing*
Still Active?*

YesNo
Narrative Description
Official Narrative Description*

In two-hundred fifty (250) words or less, please tell the Sponsor about the dog, any relevant details about the Photograph, and explain why the dog pictured deserves the American Humane Lois Pope LIFE Center for Military Affairs K9 Medal of Courage Award.0/250
Photographer's Information

Please attach a photograph of the Nominated Dog
Upload Photo*

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Sponsor reserves the right to require a written release from the photographer and/or an additional photograph that meets Sponsor’s requirements.
Photographer's Name*

First NameLast Name
Photographer over 18 years of age?*

YesNo
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Nominating Party's Signature*

Clear
Should be Empty:

Nominating Party's Information

Credentials

Narrative Description

Photographer's Information