Purple Heart Entity Application
Thank you for your interest in becoming a Purple Heart Entity through Military Order of the Purple Heart Chapter 598.

The Purple Heart Entity Program recognizes entities that are willing to make a sincere, visible, and lasting commitment to honor Purple Heart recipients and combat wounded veterans.

Becoming a Purple Heart Entity is more than receiving a sign or public recognition. It is a commitment to honor the meaning of the Purple Heart Medal with dignity, respect, and sincerity.

Applications are reviewed by MOPH Chapter 598 to ensure the recognition reflects the meaning of the Purple Heart Medal and the mission of our chapter. Approved Purple Heart Entities may receive local recognition through Chapter 598 and will be submitted for inclusion in the National Purple Heart Trail program listing.
Sign in to Google to save your progress. Learn more
Entity Name *
Entity Type:
Physical Address of Entity (PO Box is acceptable) including city state and zip code.   *
Website and/or Social Media Page *
Primary Contact Name (First, Last, Title) *
Primary Contact Phone Number *
Primary Contact Email *
Why does your entity want to become a Purple Heart Entity? (Please explain why honoring Purple Heart recipients and combat wounded veterans is meaningful to your entity.)
How does your entity currently support veterans, service members, families, or the community? *
What does the Purple Heart Medal mean to your entity? *
What type of Purple Heart recognition are you requesting? *
Required
Where would the Purple Heart designation sign be displayed? (Please describe the proposed location, such as entrance area, parking area, lobby, public space, community area, or other visible location.)
Is the designation sign location visible to the public?
If requesting a Purple Heart parking sign, how many signs are you requesting?
Do you have permission or authority to display Purple Heart signage or recognition at this location? *
Required
Please confirm the following statements. *
Required
Name of Person Signing Proclamation Application (First, Last, Title) *
Electronic Signature: (By typing your full name, you certify that the information submitted is accurate and that you are authorized to submit this application on behalf of the entity listed above.) *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report