Please complete sections 1-4. The information you provide in section 3 will be printed as submitted and be made available to all Fellows for voting. You should also submit a maximum of two pages CV with this application form as your nomination will need to be ratified by the Nominations Panel. The Form and CV will be used by the starred candidate Panel to make a recommendation to the Fellowship for voting.

Candidates should submit this nomination form and a two page CV at latest on Friday 3 June 2016 5pm GMT to the Governance Manager and Legal Counsel email to . Only electronic applications will be accepted. Please note you do not have to have completed the ten nominations, this must be with the Governance and Legal Counsel no later than 24th June.

Section 1: Basic information, please provide the following information.

Title: / Fellowship
Number:
Full Name:
Organisation:
Occupation:
Contact E-mail Address
Contact Telephone Number

I wish to be nominated for the positions of RSA Trustee. Section 2: Declaration of Willingness to Stand

Please check the box confirm you have attached a two page CV and fully completed the form. Incomplete forms will not be put forward to the nominations panel and the election process. By completing confirming the truth of the contents of your nomination and that you are willing to be nominated for the post of Trustee and will abide by RSA Election Rules. / ☐

Section 3: Candidate’s Statement

Your statement should answer the questions outlined below; each answer should not exceed 150 words. Any answers over 150 words will invalidate your nomination.

Summarise the key skills you would bring to the Board (you may want to reference the Skills Audit findings in doing so)?

What is my current involvement within the RSA?

What do I see as major challenge for the RSA over the next three years?

Section 3: Nomination by 10 Fellows

Please provide the details of the 10 Fellows, who propose you. Please note: all individuals may be contacted on behalf of the Board to confirm their willingness to support your application; and must be fully paid up members.

Nomination 1

Name: / Fellowship Number:

Nomination 2

Name: / Fellowship Number:

Nomination 3

Name: / Fellowship Number:

Nomination 4

Name: / Fellowship Number:

Nomination 5

Name: / Fellowship Number:

Nomination 6

Name: / Fellowship Number:

Nomination 7

Name: / Fellowship Number:

Nomination 8

Name: / Fellowship Number:

Nomination 9

Name: / Fellowship Number:

Nomination 10

Name: / Fellowship Number:

Trustee Nomination Form 2016 - page 3