Excellence in Ag Entry Form
Deadline for entry is 5p.m. on October 14, 2012
Click here for contest rules
NOTE: This applies to you and your spouse, if married. Please indicate "Husband" (H) and "Wife" (W) when applicable.
Applicant(s) (As it will be used in the program and recognition) Phonetic Pronunciation
Address City, State, Zip
Email
Date of Birth (H) Date of Birth (W) Age (H) Age (W)
Education/Degree (H) Education/Degree (W)
Short Courses or other specialized Study
Number of children Age(s)
Please bring one of the following for verification purposed the day of judging:
copy of 1099 or W-2 form
letter of recommendation from your employer on company letterhead that includes length of employment and a brief description of your job responsibilities
________________________________________________________________
By checking this box, I (we) hereby certify the information on this entry form and attached application to be accurate and true statements, made to the best of our ability. KFB reserves the right to use your photos and/or any video footage for use in promoting Farm Bureau. I have not derived a majority of my income from an owed production agricultural enterprise in any of the past three years.
BIOGRAPHICAL INFORMATION
Give 5 to 8 lines description to be used for display purposes throughout KFB Annual Meeting
PERSONAL BACKGROUND
Married Single Children
Education Level
How is your occupation involved in agriculture/agribusiness?
Please explain your personal involvement in production agriculture: (daily, seasonal...)
What opportunities exist for you to have a positive impact on agriculture?
List and explain three important issues that agriculture needs to address in the next 5 years.
FARM BUREAU EXPERIENCE
List leadership roles you and your spouse have fulfilled in Farm Bureau indicating service on committees, boards or as officers. Also list years of service.
County Farm Bureau
State Farm Bureau
LEADERSHIP EXPERIENCE
Other agricultural leadership positions held by you and your spouse such as Farm Credit, Soil Conservation, REC, FSA and others. Be sure to mention your leadership role.
Community and Service Programs participated in by you and your spouse and leadership given (church, school, etc). Be sure to mention your leadership role.
List significant offices held or awards achieved while participating in youth organizations. Be sure to mention your leadership role.
What additional award(s) and recognition have you received in the past?
What are your leadership goals for the next 5 years?
After clicking on "submit" please print the following
confirmation page as a copy of your application