Nomination Form Superior and Outstanding Achievement Award in Plant Mutation Breeding Name (Individual/Team/Institute): Country: Institution: Address: Email: List the number of mutant varieties, crop and improved traits: (Please use another page if needed) Nominating authority: _________________________________________________ Signature: ________________________________________ Date: ________________ Superior and Outstanding Achievement Award in Plant Mutation Breeding Page 1 Authorizing authority: _________________________________________________ Signature: ________________________________________ Date: ________________ Summary of achievements in plant mutation breeding (500 words maximum): Support from the Joint FAO/IAEA Division (e.g. fellowships, training courses, Superior and Outstanding Achievement Award in Plant Mutation Breeding Page 2 coordinated research projects, technical cooperation projects, and others): Information on mutant varieties Variety (name): Crop species: Parental variety or line: Mutagen: Mutant trait(s): Year of release: Period of cultivation: Peak acreage covered: Cumulative acreage covered: Percentage of dedicated area cultivated: Yield increase: Other impact information (e.g. value at farm gate, additional income per year, derived products, and others): Superior and Outstanding Achievement Award in Plant Mutation Breeding Page 3 Please make multiple copies of this table as necessary Superior and Outstanding Achievement Award in Plant Mutation Breeding Page 4