NAME OF NOMINEE DUTY STATION

POSITION (TITLE & GRADE) MERRITORIOUS PERIOD

NAME, GRADE, TITLE OF ORIGINATOR DATE

PROPOSED CITATION (Justification on Reverse)

RECOMMENDATION OF PANEL

APPROVED

DISAPPROVEDAPPROVED

DISAPPROVED

SIGNATURE

DATESIGNATURE

DATE

ACTION BY SELECTING OFFICIAL

DEPARTMENT OF HOMELAND SECURITY U.S. COAST GUARD

RECOMMENDATION FOR AWARD FOR EXCELLENCE/CERTIFICATE OF RECOGNITION

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JUSTIFICATION (Include Specific Data; List Community Act, Etc.)

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