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: Tuesday, September 02, 2014

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, 2013 - May 31, 2014]
 
Total number of cows:
Number of milking cows:
Number of dry cows:
 
Breed(s):

Enrolled in DHI testing? YesNo
If yes, does this include individual cow SCC testing? YesNo
Other testing service? (Please specify):
If other, does this include individual cow SCC testing? YesNo

Current rolling herd averages: Milk:   Fat:   Protein:
Additional breed, enter here: Milk:   Fat:   Protein:
 

Somatic Cell Count (milk plant monthly average 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)
SCC for the 12 mo. time period:
Average:
High:   Month:
Low:   Month:
Standard Plate Count (milk plant monthly average 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)
SPC for the 12 mo. time period:
Average:
High:   Month:
Low:   Month:
How many bulk tank SCC measurements are performed on your dairy each month?
How many bulk tank SPC measurements are performed on your dairy each month?

Cases of clinical mastitis detected in the 12-month period (please be accurate):
How do you detect clinical mastitis cases?

Have you been cited for a drug residue violation (milk or tissue) 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 12-month period (all reasons)?
Of the total number culled, how many were culled for udder health reasons:
 
 
How many cows died during the 12-month period (all reasons)?
How many died due to mastitis?:
 
 

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.


Return to NDQA main page
home