Social Impact Nomination Form Social Impact Nomination Form Org Name What is your organisations legal structure What is your organisations legal structureCommunity Benefit Society - CBSCommunity Interest Company Limited by Guarantee - CIC CLGCommunity Interest Company Limited by Shares – CIC CLSCompany Ltd by Guarantee - CLGCompany Ltd by Shares - CLSIndustrial and Provident SocietyCo-operative SocietyRegistered CharityCharitable Incorporated Organisation - CIOUnincorporated Association Company registration number What year was your social enterprise established? Address Main Contact Name Position Phone Number Email Address Twitter Facebook Website Instagram No of part time staff No of full time staff No of directors/trustees No of volunteers (FTE) What is your trading income for 2018 - 2019? What is your other income for 2018 - 2019? What is your total income for 2018 - 2019? What is your trading income for 2019 - 2020? What is your other income for 2019 - 2020? What is your total income for 2019 - 2020? Please give a short overview of the social enterprise, (no more than 200 words). Please explain what impact COVID-19 has had on your social enterprise and what you have done differently to overcome these issues, (no more than 200 words). Please evidence your community impact in line with your vision and objectives, (no more than 200 words). Please explain what processes you use to collate. measure and report your impact, (no more than 250 words). Please outline the various ways you collect your evidence, (no more than 200 words). Please evidence how you engage with your stakeholders, (no more than 200 words). Please demonstrate how you review and evaluate your social impact system, (no more than 250 words). Referee Name Organisation Relationship to nominee Email Address Contact Number Referee Name Organisation Relationship to nominee Email Address Contact Number 6 + 3 = Submit
