The Presidential Citizens Medal was established in November 13, 1969 to recognize U.S. citizens who have performed exemplary deeds of service for the nation. The medal is bestowed by the President and may be conferred posthumously. The Presidential Citizens Medal is one of the highest honors the President can confer upon a civilian, second only to the Presidential Medal of Freedom. Since it was established by Executive Order in 1969, approximately 100 people have been awarded the Presidential Citizens Medal.