Nominator Name
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First Name
Last Name
Organization/Agency
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Job Title
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Mailing Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Email
*
Nominee Name
*
First Name
Last Name
Nominee Farm/Ranch/Corporate Name
*
Nominee Job Title
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Nominee Mailing Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Nominee Phone
*
(###)
###
####
Nominee Email
*
Physical Farm/ Ranch Address
*
Even in the mailing and physical address are the same, please complete this section of the nomination form.
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Social Media Handles (if applicable)
Website Address (if applicable)
What commodities are produced by this business/ operation?
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How many acres of this business/ operation are involved in environmental stewardship efforts?
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Total number of people involved in the business/ operation:
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How many years have they been involved in this business/ operation?
i. Describe the nominee’s philosophy on environmental stewardship and provide an overview of why they invest in implementing agency programs/ practices that aim to protect natural resources.
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ii. Describe which agency and program the nominee primarily utilizes to implement their environmental stewardship program. Be sure to identify the current phase of the nominee’s environmental stewardship program (enrolled, operational, or maintenance). Include applicable enrollment or project start dates and project deadlines/ dates of completion (if applicable). This information should also be addressed in the verification letter required by agency staff later on in this nomination packet.
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iii. Describe the nominee’s participation in Best Management Practices and/ or agency- governed environmental stewardship programs. Be sure to include the history of the nominee’s involvement in environmental stewardship programs/ projects, how they have worked to continuously build upon each one, and any evidence resulting from them. This section should include how the nominee has implemented practices that effectively accomplish any of the following: reduce overall water use, send clean water to recharge to aquifer, protect natural areas and water quality, protect wildlife habitats, reduce overall chemical/ nutrient use, eliminate risk of drift and/ or runoff, eliminates risk of soil erosion, restores soil health, and recycle waste/by- products.
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iv. Describe how this nominee is an innovative and progressive environmental steward. What new approaches or technologies are they utilizing to best protect natural resources? Describe any participation in research efforts, application of new technologies, and education/ outreach initiatives.
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Photo/ Headshot of Nominee (PNG or JPG files only)
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Support Photos/ Videos (PNG or JPG files only)
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Support Photos/ Videos (PNG or JPG files only)
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Letter of Verification from Agency Staff (PDF files only)
*
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Letter of Recommendation #1 (PDF files only)
*
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Letter of Recommendation #2 (PDF files only)
*
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Completed Nomination Form, Sections I - V
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Photo/ Headshot of Nominee
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Supporting Photos/Videos
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Letter of Verification from Agency Staff
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Two Letter of Recommendations
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Certification Statement
Certification Signature
*
First Name
Last Name
Certification Date
*
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DD
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