Nomination for 2016 Iowa Master Pork Partner Award

Please type or print on this form.

NAME(S)______

FARM/COMPANY NAME______

ADDRESS______CITY______ZIP______

PHONE: (____)______CELL PHONE: (____)______

EMAIL ADDRESS ______

ADDRESS TO LOCATION FOR COMMITTEE VISIT (if different than above) ______

DATE OF BIRTH______YEARS IN PORK INDUSTRY ______

SPOUSE'S NAME ______

CHILDREN'S NAMES AND AGES______

ARE YOU A MEMBER OF A COUNTY PORK PRODUCERS GROUP? ______

NATIONAL PORK BOARD/ PQA PLUS CERT. NUMBER ______

NUMBER OF EMPLOYEES/GROWERS SUPERVISED______

OTHER PRIOR AWARD RECOGNITION ______

Provide a detailed description of your pork production role, company and industry experience on separate page(s). This must accompany this application to be considered for award recognition. Advancement of the We Care responsible pork initiative is central to this award. Please outline your activities and how they align with this initiative. Community involvement is a pillar of We Care and is critical for Master Pork Partner award selection. Involvement in church, school, Extension/4-H and other community leadership should be included.

Please list any local newspapers and radio stations with which we can share press information should you be selected for this award.

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This nomination form, for the Master Pork Partner nomination, must be completed and submitted to IPPA by August 22, 2016. An on-farm visit will be set up this fall by November 15th, 2016. The state winners will be notified by December 1, 2016.

SIGNATURE______DATE______

NOMINATED BY:

Please include letter of recommendation from nominator detailing why this individual stands out. (i.e. production performance, management skills and capabilities, industry/community involvement, issues and industry knowledge and other special achievements.)