RANSOM COUNTY APPLICATION FORM AGRICULTURALIST OF T HE - PDF document

RANSOM COUNTY APPLICATION FORM AGRICULTURALIST OF T HE YEAR Application d eadline: February 1 Name: Spouse: Address: Phone : Date of Birth: / / Person making nomination: Description of early life and early farming experiences and type of operation (Highlight new or innovative farming practices introduced, type of livestock, special challenges that the nominee had to overcome, etc....): ________________________________________________________________________________________________________________________ ____ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ _ ___________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ _______ _____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ _____________ _______________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ Special resource conservation practices used (windbreaks, watershed protection, soil erosion, etc....): ________________________________________________________________________________________________________________________ ____ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ _ ___________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ _______ _____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ _____________ _______________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ Education received and non - farm employment: ________________________________________________________________________________________________________________________ ____ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ _ ___________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ _______ _____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ _____________ _______________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ Description of current farming operation (who operates the unit, size, enterprises): ________________________________________________________________________________________________________________________ ____ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ _ ___________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ _______ _____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ _____________ _______________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ Community activities and leadership roles (4 - H, FFA, township, county, farm organizations, church, etc....): ________________________________________________________________________________________________________________________ ____ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ _ ___________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ _______ _____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ _____________ _______________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ Awards and achievements received: ________________________________________________________________________________________________________________________ ____ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ _ ___________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ _______ _____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ _____________ _______________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ Children, grandchildren, location, education and current job: ________________________________________________________________________________________________________________________ ____ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ _ ___________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ _______ _____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ _____________ _______________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ Other: ________________________________________________________________________________________________________________________ ____ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ _ ___________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ _______ _____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ Person to contact for additional information on nominee: Name __________________________________ _ _________ _________ Phone: ____ ____________ _________ _________ Address _______________________________________ ______________________________________________________________ ____ Email ___________________________________________ _______________________________ Please return completed application to: Ransom County Extension Courthouse, 204 5 th Ave W. PO Box 950, Lisbon ND 58054 OR AgCountry Farm Credit Services PO Box 33, Lisbon ND 58054 . Ransom County Crop & Livestock Improvement Association PO Box 950, Lisbon ND 58054 NDSU is an EO/AA university.