Social Investment Nomination Form 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 13 + 8 = Submit