Social Investment 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

Email Address

Phone Number

Facebook

Twitter

Instagram

Website

No of full time staff

No of part time staff

No of volunteers (FTE)

No of directors/trustees

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 explain why social investment was needed, (no more than 200 words).

Please explain the method used to secure social investment (no more than 250 words).

Please demonstrate what social/environmental impact the investment had on your social enterprise, (no more than 250 words).

Please outline your future plans for the social enterprise and how the social investment will further support the organisation, (no more than 300 words).

Referee Name

Organisation

Relationship to nominee

Email Address

Contact Number

Referee Name

Organisation

Relationship to nominee

Email Address

Contact Number