Edward H Bean Application.doc Page 1 of 2

Edward H. Bean Award

2017 A p p l i c a t i o n

All applications are due by close of business on June 1, 2017, and must be compiled into one PDF file.

Please make sure the file name reflects both the award name and the institution. Abbreviations are fine.

AZA has contracted with WEBCARGO to provide a quick and easy way for you to submit your application. Please submit your application using this link:
https://www.webcargo.net/request/index/id/5860789/dp/0hx6wVPdIBVUnLusCc

WEBCARGO allows you to send large files via email, without the need to reduce their size. There is no need to sign up, nothing to install andnothingto download. All deliveries are encryptedso security is not an issue and WEBCARGO sends confirmation when your file is received.The upload speed varies depending on your Internet Service Provider and the size of your file so you may need to be patient. Please send a note to support.webcargo.net if you need assistance with the upload.

Questions? Please contact Barbara Pueschel (; 301-244-3326).

See 2017 Edward H. Bean Award Guidelines for information about completing this application.

A. CANDIDATE

Vernacular name:

Scientific name (include subspecies if applicable and known):

B. APPLICANT

Institution Name:

Address:

Name of Director:

Signature of Director:

C. BASIC INFORMATION PERTAINING TO PROGRAM

Date program began:

Please include a description of the history of this species/subspecies in the collection and any prior propagation efforts. Also, explain any management and husbandry techniques utilized to stimulate and ensure this breeding success.

Additional information such as behavioral observations, nutritional data, or bibliography of publications (in print or in the process of being published) will assist the committee in its deliberations.

Reason program was initiated:

Total number of specimens in breeding group:

Length of time specimens of this species/subspecies has been maintained in collection:

Was this a first birth/hatching of this species/subspecies in the collection? Yes No

Which generation does the most recent birth/hatching represent?

Has this program previously been submitted for an AZA award? Yes No

If yes, did it win an award? Yes No

D. MANAGEMENT AND HUSBANDRY

1)  How is the breeding program significant for the species or subspecies and/or to other species as well as its impact on wild counterparts?

2)  Can the program be, or has it been duplicated at other institutions?

3)  How has, or how will, the husbandry and research be made accessible to other institutions?

4)  Has the program benefited species/subspecies anywhere else and how?

5)  How does disposition of offspring enhance the long-term, successful maintenance of the species?

6)  How does this program support the applicable TAG and/or SSP goals for the species?

E. IMAGE—one digital image that illustrates the program—to be used during the AZA Annual Conference Awards Ceremony.

F. PARTICIPATION

Name and institution of those to be acknowledged for their participation in the program:

Describe the long-term commitment of the institution to this breeding program.

G. COLLABORATION (if applicable)

Name(s) and AZA membership number(s) of collaborating institution(s):

H. SUBMITTER

The SUBMITTER is that person responsible for the contents of the entry. Failure to provide an electronic signature on the designated line will constitute an incomplete application.

Name:

Title:

Signature:

Date:

E-mail address:

I. NEWS RELEASE FORM

Submit the News Release Form (available at https://www.aza.org/bean-award/) with the application and also email the form as a WORD document to Barbara Pueschel:

J. WINNER’S RELEASE: HELP YOUR FELLOW MEMBERS!

If yours is the winning application, would you be willing to have it posted on the AZA website?

Yes No

Edward H Bean Application.doc Page 1 of 2