Excellence in Agriculture

Name (A1)(Required)

First Last

Name (A2)

First Last

Phonetic Pronunciation

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

County(Required)

Membership Number(Required)

Phone Number (A1)(Required)

Phone Number (A2)

Email (A1)(Required)

Email (A2)

Date of Birth (A1)(Required)

Date of Birth (A2)

Education/Degree (A1)

Education/Degree (A2)

Short Courses/Specialized Study (A1)

Short Courses/Specialized Study (A2)

Children (Name & Age)

Name

Age

Please provide one of the following for verification purposes: (check which form you are providing)

Copy of Form 1099 or Form W-2

A letter of verification from your employer/company on letterhead that includes length of employment and a brief description of your job responsibilities

Please upload whichever form you choose here.

Max. file size: 2 GB.

NOTE: NO COUNTY IDENTIFIERS

The application must be completed in first person narrative (i.e., I, me, we, etc.) for questions 1-5. Indicate Applicant 1 (A1) and Applicant 2 (A2) on question 6.

1. PERSONAL BACKGROUND

Briefly explain your family, education and personal interests.

2. AGRICULTURAL INVOLVEMENT

A. Please explain the applicant(s) occupation .

B. Please explain the applicant(s) personal involvement in agriculture/agribusiness.

3. IMPACT ON AGRICULTURE

Clearly describe the efforts the applicant(s) have taken to positively promote and impact the agriculture industry. Examples may include things such as hosting farm tours, legislative visits, writing a blog, etc.

4. ISSUES FACING AGRICULTURE

A. Agriculture faces important issues at the local, state, national and international levels. Explain three important issues that the industry needs to address in the next five years. Choose one issue from three of the four levels mentioned above. For example, an applicant might select ag literacy as a local issue, mental health as a state issue and rural broadband as a national issue.

B. Choose one of the issues in your response to 4A and discuss how you personally have addressed, or can address, that issue and work towards a resolution.

5. GOALS

What goals does the applicant(s) have for the next five years related to his/her career, Farm Bureau involvement and involvement with other organizations? What steps have been made to reach these goals?

6. LEADERSHIP EXPERIENCE (from age 18 to current):

List Farm Bureau leadership roles, involvement opportunities, recognitions and/or awards received by the applicant(s), indicating service on committees, boards or as officers. Please include years of involvement. Note: This applies to both applicants, if applying together. Please indicate A1 and A2 when applicable.

County Farm Bureau

Example: A1 – Elected President of the County Farm Bureau Board of Directors (2018-2019)

State/American Farm Bureau

Example: A1 – Elected President of the County Farm Bureau Board of Directors (2018-2019)

6. LEADERSHIP EXPERIENCE (continued):

Note: This applies to both applicants, if applying together. Please indicate A1 and A2 when applicable.

List other agricultural leadership roles, involvement opportunities, recognitions and/or awards received by the applicant(s), indicating service on committees, boards or as officers. (i.e. Farm Credit, Soil Conservation, Farm Service Agency, farm cooperatives, 4-H, etc.) Please include organization, description and years of involvement.

Example: A1 & A2 – 4-H, Serves as a 4-H livestock Club Leader (2018-present)

List other community and non-agricultural leadership roles, involvement opportunities, recognitions and/or awards received by the applicant(s), indicating service on committees, boards or as officers (i.e. civic/service clubs, church, school, volunteer leadership, etc.) Please include organization, description and years of involvement.

Example: A1 – Local Elementary School, Serviced as Parent Teacher Association (PTA) President (2018-2020)

If you had any situations or circumstances that my affect your leadership experiences, please us this space to explain. If you don’t have any situations or circumstances, please leave blank.

Note: There are no points associated to this section and can be left blank.

Upload W-9 form

Max. file size: 2 GB.

Please upload your W-9 form here, as it is a requirement for you to receive your award money.

Important Application Info:

If you do not receive a confirmation email, assume your application is not submitted. You are highly encouraged to keep a word document copy of your application. You may copy from your own document and paste into the online application.

Excellence in Agriculture

YF&R Excellence in Agriculture Application

NOTE: NO COUNTY IDENTIFIERS

1. PERSONAL BACKGROUND

2. AGRICULTURAL INVOLVEMENT

3. IMPACT ON AGRICULTURE

4. ISSUES FACING AGRICULTURE

5. GOALS

6. LEADERSHIP EXPERIENCE (from age 18 to current):

6. LEADERSHIP EXPERIENCE (continued):

Important Application Info:

Quilted Pullover

ROTM | More Than 50 Years of Fruit & Wisdom with Dr. Dave Lockwood

Tennessee Home and Farm

Excellence in Agriculture

YF&R Excellence in Agriculture Application

NOTE: NO COUNTY IDENTIFIERS

1. PERSONAL BACKGROUND

2. AGRICULTURAL INVOLVEMENT

3. IMPACT ON AGRICULTURE

4. ISSUES FACING AGRICULTURE

5. GOALS

6. LEADERSHIP EXPERIENCE (from age 18 to current):

6. LEADERSHIP EXPERIENCE (continued):

Important Application Info:

Quilted Pullover

ROTM | More Than 50 Years of Fruit & Wisdom with Dr. Dave Lockwood

Tennessee Home and Farm

In the Loop