Schaumburg Township Request for Public Record Form

Schaumburg Township Residents
Veterans Honor Roll Application

If you prefer to print out and mail this Application please mail it to:

Schaumburg Township
C/o Veterans Honor Roll
1 Illinois Blvd.
Hoffman Estates, IL 60169-3314

Please complete the following information.	*Required Form Fields.

*Name:
Address:
City/Zip Code:
Phone #:
*Email:
Date of Birth:
Branch of Service:
Highest Rank Attained:
Years of Service: (From: M/D/Y - To: M/D/Y)
Medals Awarded or other Citations:
Injuries (if any):

The nominee served in a time of conflict.
The nominee must reside within the Schaumburg Township.
The nominee must have an honorable discharge from the U.S. Military.
The nominee must attach a copy of their discharge papers or DD-214.
The nominee can include any brief stories of events and/or memories of
their time in the Military. Please include additional sheet(s) if needed.

Nominations can be submitted to the Clerk Timothy M. Heneghan/Veterans Honor
Roll, Township of Schaumburg, One Illinois Blvd., Hoffman Estates, IL 60169-3314.

Veterans recognition will be held at the Township during the regular scheduled
Board of Trustees Meeting.

Thank you,

Clerk

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