MIXED FARMER OF THE YEAR ENTRY FORM

1. Full Name of Nominee

2. Phone Number:

3. Email Address (if available)

4. Farm / Business Address

5. District & Province

6. Age

7. Name of Farm / Agribusiness

8. Year Business Started

9.Size of Farm (Land area in hectares)

10. What mixed enterprises do you currently run? (Select all that apply)Crop ProductionLivestock (Cattle/Goats/Sheep)PoultryPiggeryAquacultureHorticulture / VegetablesAgro-processing

11. Briefly describe your main farming operations (max 200 words)

12. Explain how your different enterprises complement each other (integration, resource use,recycling, etc.):

13. What business strategies do you use to ensure profitability?

14. List your major products and target marketsProduct 1Product 2Product 3

15. Do you add value to any of your products?YesNo

16. What technologies, innovations, or mechanisation do you use on your farm? (e.g.,irrigation, tractors, housing systems, digital tools)

17. Describe any sustainable or climate-smart practices you use

18. Number of workers employed (permanent & seasonal)

19. Do you train, mentor, or support other farmers in your community? Describe how

20. Highlight key achievements from the last 3 years

Farm photos (up to 5)

Short farm video (optional)

Business registration or cooperative membership (optional)

Full Name

Date

MIXED FARMER OF THE YEAR ENTRY

Section 1: Nominee Details

SECTION 2: FARM & BUSINESS INFORMATION

SECTION 3: PRODUCTION & BUSINESS PERFORMANCE

SECTION 4: INNOVATION & TECHNOLOGY

SECTION 5: IMPACT & COMMUNITY CONTRIBUTION

SECTION 6: ACHIEVEMENTS

SECTION 7: MEDIA UPLOADS

SECTION 8: DECLARATION

Agricoop Awards

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