<p> Nomination for 2016 Iowa Master Pork Partner Award</p><p>Please type or print on this form.</p><p>NAME(S)______</p><p>FARM/COMPANY NAME______</p><p>ADDRESS______CITY______ZIP______</p><p>PHONE: (____)______CELL PHONE: (____)______</p><p>EMAIL ADDRESS ______</p><p>ADDRESS TO LOCATION FOR COMMITTEE VISIT (if different than above) ______</p><p>DATE OF BIRTH______YEARS IN PORK INDUSTRY ______</p><p>SPOUSE'S NAME ______</p><p>CHILDREN'S NAMES AND AGES______</p><p>ARE YOU A MEMBER OF A COUNTY PORK PRODUCERS GROUP? ______</p><p>NATIONAL PORK BOARD/ PQA PLUS CERT. NUMBER ______</p><p>NUMBER OF EMPLOYEES/GROWERS SUPERVISED______</p><p>OTHER PRIOR AWARD RECOGNITION ______</p><p>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.</p><p>Please list any local newspapers and radio stations with which we can share press information should you be selected for this award.</p><p>______</p><p>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. </p><p>SIGNATURE______DATE______</p><p>NOMINATED BY: </p><p>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.) </p>