ENVIRONMENTAL CHAMPION OF THE YEAR ENTRY

SECTION 1: NOMINEE DETAILS

1. Full Name / Organization Name

2. Contact Person (if organization)Name

Position

3. Phone Number

4. Email Address

5. Physical Address / Location

6. Province & District

7. Age (if individual nominee)

8. Gender (if individual nominee)

SECTION 2: ENVIRONMENTAL INITIATIVES

9. Brief description of the environmental initiatives undertaken (max 300 words)

10. Areas of focus: (Select all that apply)Climate-smart agricultureWater conservation / irrigation efficiencySoil fertility / conservationWaste management / recyclingRenewable energy / solar pumpsAgroforestry / tree plantingBiodiversity protection

11. Describe innovative practices or technologies used to protect the environment

12. Scope of impactNumber of farmers or beneficiaries reached

Area of land covered (hectares)

Other measurable results (e.g., tonnes of waste reduced, trees planted)

SECTION 3: BUSINESS & COMMUNITY IMPACT

13. How has the initiative contributed to sustainable agricultural business practices?

14. Community involvement and awareness activities

15. Partnerships or collaborations with organizations, government, or communities

SECTION 4: ACHIEVEMENTS & RECOGNITION

16. Awards, recognitions, or certifications received

17. Key successes in the last 3 years

SECTION 5: SUPPORTING MATERIALS

18. Upload supporting materials

Photos or videos of initiatives

Reports or documentation of activities

Certificates or awards (optional)

SECTION 6: DECLARATION

I confirm that the information provided is accurate and true to the best of my knowledge. I consent to Agricoop Awards using this information for judging, verification, and official awards-related communication.

I also agree that Agricoop Awards’ partners and sponsors may contact me for legitimate business or collaboration purposes connected to the awards.I agree to the declaration.

Full Name / Representative Name

Position (if organization)

Date

Deadline: 05/30/26

Inquiries: info@agricoopnews.com or Whatsapp +260 950606852

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