Steve Atkisson Indiana Dairy Service Award - Must be submitted by January 15, 2019
Presented By The Indiana Milk Quality Professionals, Inc.

Nomination Form
Award Criteria:
1.) An individual who has made a significant positive impact on Indiana’s dairy industry over a number of years.
2.) The individual can be retired from or active in the Indiana dairy industry.
3.) The individual may be living or deceased at the time of the nomination.
4.) The individual does not need to be a resident of Indiana.
5.) It is recommended but not required that the individual have involvement in the Indiana Milk Quality Conference.
6.) The Indiana Milk Quality Professionals, Inc. Board of Directors and Advisory Committee will be the selection committee for the award.
7.) One award will be presented each year.
8.) Any person involved in the Indiana Milk Quality Professionals, Inc. may nominate an individual for the award.

Name of Nominee *
Your answer
Address *
Your answer
Spouse’s Name *
Your answer
Name of Children *
Your answer
Organizations and Activities (Industry & Personal) *
Your answer
List of Recognitions and Awards Received *
Your answer
Employer and Date of Employment *
Your answer
Years of Service in the Dairy Industry *
Your answer
Accomplishments and Leadership *
Your answer
Nominated By (Optional)
Your answer
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