Kentucky Colonel Commission

Kentucky Colonel Commission Application

Commonwealth of Kentucky
Matthew G. Bevin, Governor

Nominee Information

*Nominations require a minimum of 30 days for processing.

* First Name:

Middle Initial:

* Last Name:

Suffix:

* Date of Birth:

Ex: 01/01/1970 (must be 18 years of age or older)

International Address:

Yes

* Address Line 1:

Address Line 2:

* City:

* State:

* International Address:

* Zip Code:

* Phone Number:

Ex: 555-555-5555

* Tel:

* Email Address:

Ex: example@kentucky.gov

* Profession:

* Please list active service in a charitable organization or community service:

* Reason for Recommendation:

Recommended By:
Note: Only active members of the Honorable Order of Kentucky Colonels may make recommendations. For more information on your membership status, please contact the Honorable Order of Kentucky Colonels at (502) 266-6114.

* Honorable Order of the Kentucky Colonel Membership Number:

* First Name:

Middle Initial:

* Last Name:

International Address:

Yes

* Address Line 1:

Address Line 2:

* City:

* State:

* International Address:

* Zip Code:

* Phone Number:

Ex: 555-555-5555

* Tel:

* Email Address:

Ex: example@kentucky.gov

* Profession:

* If issued, the commission will be mailed to (please check one):

Recommender

Recipient

* Is the commission for a presentation ceremony, or a gift?

* Date of presentation:

Ex. 01/01/1970

Security

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