Mathias - Lesczynski 2016 Award

Applicants will be considered for the award upon submitting a completed entry form no later than December 1, 2016. The application can be submitted in a number of ways:

• Complete and submit the form on this page, matching the numbered question to the number on the form
• Download the form as a Word document, then submit as an attachment on the form below or email to contact@lwqia.org
• Print the Word document, then fill it in by hand and mail to: LWQIA, PO Box 1716, Fond du Lac, WI 54936-1716

Supporting materials (maps, photos, etc.) may be scanned and attached to form, emailed or mailed.

L.W.Q.I.A. may request award recipients and selected applicants to participate in advancing the Mathias / Lesczynski Award program by sharing their accomplishments during various L.W.Q.I.A. promotional efforts.

• 1)  Applicant(s) Name
• 2)  Farm/Business Name (if different)
• 3)  Mailing Address
• 4)  Location of Operations (if different)
• 5)  Phone
• 6)  Email
• 7)  Type of Farm Operation (dairy, cash crop, etc.)
• 8)  Describe changes you have made in conditions and/or operations for the 2016 growing season to help protect surface waters from runoff of sediment, nutrients and chemicals.
• 9)  What were the expected or observed results of these changes to conditions/operations?
• 10)  What local, state or federal agencies or other organizations or consultants assisted you in designing and/or implementing these changes?
• 11)  List any community service, agricultural, or conservation organizations in which you are active and indicate any leadership roles.
• 12)  Type in the name of the person filling out the form
• 13)  Date