1.Your name (this will not be shared with your nominee)

2.Your firm/organisation (this will not be shared with your nominee)

3.Name of nominee

4.Name of nominee's firm/organisation

5.Location of nominee (eg London, Glasgow, Manchester, the North West, Scotland)

6.Why are you nominating this person? (this will not be shared with your nominee)

7.What activity has this person taken part in in the last 1-2 years that supports this nomination? (this will not be shared with your nominee)

8.Is there anything else you would like to add? (this will not be shared with your nominee)