Start Up Social Enterprise 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 2020 - 2021?

What is your other income for 2020 - 2021?

What is your total income for 2020 - 2021?

What is your trading income for 2021 - 2022?

What is your other income for 2021 - 2022?

What is your total income for 2021 - 2022?

Please give a short overview of the social enterprise, (no more than 200 words).

Please tell us about any changes you have made due to the impact of the Covid-19 pandemic, (no more than 200 words).

Please explain what your forward looking strategy and future aims are, (no more than 250 words).

Please evidence how you have overcome challenges as a social enterprise start up, (no more than 200 words).

Please evidence how you have been creative in tackling problems, (no more than 200 words).

Please explain why you have strong potential for future success, (no more than 250 words).

Referee Name

Organisation

Relationship to nominee

Email Address

Contact Number

Referee Name

Organisation

Relationship to nominee

Email Address

Contact Name