National Dairy Quality Awards
Nomination Form


Please use upper and lower case when entering information. 
DO NOT USE ALL CAPITAL LETTERS and do not use all small letters (or your application will be rejected).
 
Deadline for applications: September 10, 2011
NOMINATOR INFORMATION
 
First Name:
Last Name:
Company/Organization
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
Position (please select one): veterinarian extension specialist fieldstaff DHI supervisor other:

FARM INFORMATION
 
Farm Name:
Owner's First Name(s):
Owner's Last Name(s):
Address:
City:
State:
Zip:
Phone:
Fax:
Email:

FARM DATA [for the 12-month time period of June 1, 2010 - May 31, 2011]
 
Total number of milk cows:

Breed:

DHIA member?YesNo           Other testing service:

Current rolling herd averages ... Milk: Fat: Protein:

Somatic Cell Count (milk plant records): Please be accurate. Monthly records are required for final applications.
Please enter values without thousands. (For example if High value is 200,000 please enter 200)

    Average (12 mo. time period):    High: Month: Low: Month:

Standard Plate Count (milk plant records): Please be accurate. Monthly records are required for final applications.
Please enter values without thousands. (For example if High value is 3,000 please enter 3)
    Average (12 mo. time period):    High: Month: Low: Month:

Cases of clinical mastitis detected in the 12-month period:

How do you detect clinical mastitis cases?


Have you been cited for an antibiotic residue violation in the 12-month period? Yes No
    If yes, when: mm/dd/yyyy

    If yes, what was the cause of the incident?

How many cows were culled during the time period (all reasons):
    Of the total number culled, how many were culled for udder health reasons:  
Any additional comments (optional):
PLEASE NOTE: After submitting your form, you should see a screen which confirms your nomination and you should receive an email confirmation. If you do not receive a confirmation, your application may not have been processed. If this happens, please contact the NMC office.

Please do not hit the submit button more than once.
 
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