NOMINATION FOR HONORS AWARD

Southern Branch, American Dairy Science Association

NAME:_____________________________________________________________

ADDRESS:__________________________________________________________________

___________________________________________________________________________

DATE OF BIRTH: ____________________________

PRESENT POSITION: ________________________________________________________

SUPPORTING DATA: This should include statements on the following:

1) Academic Training

2) Positions Held

3) Professional Attainments

4) Publications

5) Participation in Southern Branch ADSA

6) Participation in National ADSA

7) Extracurricular Activities, including civic and other

8) Letter of Recommendation from fellow workers, professors, and students. (use extra sheet if necessary)

NOMINATED BY: ____________________________________________________

DATE: ______________

ADDRESS: _________________________________________________________________________

_____________________________________________________________________________

SEND TO:

Dr. Ken Butcher North Carolina State University Department of Animal Science Box 7623 Raleigh, NC 27695-7623

COPIES NEEDED: Three

DEADLINE: October 17, 2000