A selection screening committee, appointed by and approved by the Missouri Livestock Symposium Committee, will rate the top application(s). These will then be sent to the Missouri Livestock Person of the Year Committee, which will in turn submit their recommendation(s) to the Missouri Livestock Symposium Committee for final approval.

1. Eligible applicants must have been residents (do not have to be current residents) of one of the following Northeast Missouri Counties:  Adair, Clark, Knox, Lewis, Linn, Macon, Marion, Monroe, Pike, Putnam, Randolph, Ralls, Schuyler, Scotland, Shelby or Sullivan.

2. Living or deceased eligible.

3. Individual receiving award must have made a significant contribution to the livestock industry.

4. Producers, agribusiness personnel, agency personnel, or agricultural educators or researchers are all eligible to receive this award. Other parties who have been long-time supporters of the northeast Missouri livestock industry will also be seriously considered.

APPLICATION
NORTHEAST MISSOURI
LIVESTOCK PERSON OF THE YEAR AWARD

Section A:  General Information

       1.      Name of Applicant:

Mailing Address:

Email Address:  

Telephone Number:

2.      Name of Submitter: 

Mailing Address:

Email Address:  

Telephone Number:

3.      Recommended family contact(s) if different than applicant or submitter shown above.

Name                                                                              Phone                             

Address                                                                                                                 

Email address:                                                                                                        

* a family contact may be needed should the screening or selection committees require more information about the applicant.

Section B:  Background Information

1.     Applicants involvement in the livestock industry. 
     (Using an X, please mark those sections that best describes the applicant.)

                 A.  Livestock Producer

                 B.  Agribusiness Affiliation – please specify type of affiliation or job title.

                 C. Agricultural education or agency affiliated with livestock production.
                      Give position title or job description.

                 D. Other. (Supporter type not shown in A-C above. 
                      Please specify title or support type.) 

2.  Past awards or honors applicant has received related to the livestock industry 
     (attach additional pages if needed).

            Local: 

Regional:

Statewide:

National:

3.    List community activities and/or organizational memberships (include offices held,
      memberships in church, civic clubs, etc., attach additional pages if needed)

Written statement by applicant or submitter describing why the applicant should be considered for this award. Attach additional pages as necessary.

Applicants or family members (in case applicants are deceased) are required to sign the release form below which allows the Missouri Livestock Symposium Committee to process the application and publicize this award should the applicant be chosen. This form should be signed, dated and returned with the application package.

Release Form

Applicants signature                                                                                                     
(Or family member in case of deceased applicant.)

Printed name of applicant                                                                                             

Date of signature                                                                 

The above signatures indicate the applicant above, or those representing the applicant, agree to allow the Missouri Livestock Symposium Committee and its committees to proceed with the selection and review process and further allows the Missouri Livestock Symposium Committee to publicize this applicant as the award winner should that occur.