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2019 Monument To Freedom, Justice & Courage Nomination

  1. 2019 Monument To Freedom, Justice and Courage Nomination

  2. Jackson County Seal

  3. NOTES: To submit this form you do not have to sign in or create a Jackson County Form Center account above. However, you will have to complete the form in its entirety without the option to save your progress unless you do create an account.

    The Jackson County Freedom Wall Commission seeks to recognize outstanding individuals who have demonstrated, either currently or in the past, exceptional leadership qualities in their ongoing efforts to enhance the quality of life in the urban community of Jackson County, Missouri.

    All nominations must be submitted by 4:30PM CST, Wednesday, July 31, 2019 and must be complete when submitted including a bio of the Nominee. (Note: Please make sure that your Nominee meets the criteria as directed by the Freedom Wall Commission. Review the criteria link http://www.jacksongov.org/996/Monument-Recognition-Criteria if necessary.)

    If you have any questions, please email Kay Jenkins at KJenkins@JacksonGov.org or call (816) 881-3163.

  4. NOMINEE INFORMATION

  5. Posthumous*

  6. Please provide a bio of the person you are nominating. (.doc and .pdf files only)

  7. Submitted/Nominated By

  8. Nomination On File*

    If your Nominee is not selected, would you like us to keep his\her form on file for future consideration?

  9. Acknowledgement*

    By clicking "I agree," you agree and acknowledge that information provided in this form is, to the best of your knowledge, true and accurate.

  10. e-Signature

    By typing your name in the "Signature" box below, you acknowledge that this "electronic signature" is valid and binding upon you to the same force and effect of a traditional handwritten signature.

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