Form FDACS-01597 "Woman of the Year in Agriculture Application for Nomination" - Florida

Form FDACS-01597 is a Florida Department of Agriculture and Consumer Services form also known as the "Woman Of The Year In Agriculture Application For Nomination". The latest edition of the form was released in March 1, 2017 and is available for digital filing.

Download an up-to-date fillable Form FDACS-01597 in PDF-format down below or look it up on the Florida Department of Agriculture and Consumer Services Forms website.

ADVERTISEMENT

Download Form FDACS-01597 "Woman of the Year in Agriculture Application for Nomination" - Florida

239 times
Rate
(4.7 / 5) 12 votes
Florida Department of Agriculture and Consumer Services
Office of External Affairs
APPLICATION FOR WOMAN OF THE YEAR
ADAM H. PUTNAM
COMMISSIONER
IN AGRICULTURE
Phone (850) 617-7700
Instructions and criteria for nominations for Woman of the Year in Agriculture
This form may be typed, hand written, or filled out online and printed. Mail completed and signed
application form to:
Commissioner Adam H. Putnam
Florida Department of Agriculture and Consumer Services
Office of External Affairs
The Capitol
Tallahassee, Florida 32399-0800
(850) 617-7700 Telephone
www.FreshFromFlorida.com/AgWoman
or
To access this form online, go to:
http://forms.freshfromflorida.com/01597.pdf
If you fill out the Application online and want to keep an electronic copy on your computer, use the “Save
As” command under the “File” menu, and save the document to your hard drive. If you close the
document without saving, your information will be lost.
Applicants should meet the following criteria:
Age:
Must be at least 25 years of age.
Residence:
Must be active in the agriculture industry and have resided in the
State of Florida for the past ten consecutive years.
Experience:
Must have at least ten years of experience in the agriculture
industry.
Community Service:
Must have served her community in some professional and/or
civic capacity.
Contribution to Agriculture:
Must have made some unique or outstanding contribution to the
agriculture industry.
SUBMISSION DEADLINE – JUNE 1
For questions, please contact Clay Hollis at (850) 617-7700
FDACS- 01597 Rev. 03/17
Page 1 of 4
APPLICATION FOR WOMAN OF THE YEAR IN AGRICULTURE
This form must be completed in full and signed.
Name of Person Making Nomination:
Address:
City:
State:
Zip:
Telephone:
Mobile:
Email Address:
How is the nominee known by you?
Why do you feel this nominee should be chosen for the Woman of the Year in Agriculture?
Nominee's Personal Information
1. Name:
Dr./Mr./Mrs./Ms.
First
Middle/Maiden
Last
Nickname/Preferred Name:
2. Has the nominee ever been known by another name?
Yes
No
If yes, give other name(s) and explain:
3. Spouse's Name
:
4. Children(s) Name and Age:
5. Residence Address:
City:
County:
State:
Zip:
Telephone:
Mobile:
FDACS- 01597 Rev. 03/17
Page 2 of 4
APPLICATION FOR WOMAN OF THE YEAR IN AGRICULTURE
6. Business Address:
City:
County:
State:
Zip:
7. Birth Date:
Place of Birth:
8. For how long has the nominee been a continuous resident of Florida?
Education
9. High School Name:
City:
State:
10. Postsecondary Institution:
Name/Location
Years Attended
Certificate/Degree Earned
Employment
11. Is the nominee currently employed in the agriculture industry?
Yes
No
If so, please describe her role:
Special Questions (attach additional pages as necessary)
12. List any special qualifications, accomplishments and/or recognitions this nominee has
received, that makes her the best candidate for Woman of the Year in Agriculture:
FDACS- 01597 Rev. 03/17
Page 3 of 4
APPLICATION FOR WOMAN OF THE YEAR IN AGRICULTURE
13. Please describe below the nominee's outstanding or unique impact or contribution to Florida
Agriculture:
14. Please attach any video, newspaper articles, pictures, biography or letters of support that you
feel would assist the nominating committee in making their selection with regards to this
nominee being chosen as Woman of the Year in Agriculture. (This is not mandatory for
selection, but encouraged)
Signature
Date
FDACS- 01597 Rev. 03/17
Page 4 of 4
ADVERTISEMENT