Stelios Award for Disabled Entrepreneurs in the UK 2013

Stelios Award for Disabled Entrepreneurs in the UK 2013

Application Form - Nomination

Eligibility criteria for the nominee

• Has a recognised disability or long term health condition
• Has at least 25% management stake in the company
• Business has a turnover in excess of £10,000
• UK registered business
• Trading for between 1 and 5 years

* Mandatory fields

Please complete form electronically

To nominate someone for the Award, please answer the following questions before asking the nominee to complete the form and submit before the deadline.

* Your Name * Nominee’s Name

* Your Relationship to Nominee * Nominee’s Company Name

* Your Phone Number * Your Email Address

* Why are you nominating this entrepreneur for the Award?

* As a disabled entrepreneur, what are some of the challenges that the nominee has faced and how have they overcome them? (200 words allowed)

* Please tell us how you found out about this year's Award

Word of Mouth

Leaflet ______

Search Engine ______

Website ______

Article ______

Other ______

Contact Details

* First Name * Last Name

* Date of Birth

/ /

* Company Name

* Company Address

Address line 2

* City* Postcode

* Country

* Email Address Website Address

* Telephone Number Mobile Number

Company Details

* Business Sector

* Nature of Business

* Main Product/Service

* Number of Employees

* Legal Status of Company

* Date Business Registered* Date Trading Began

(No earlier than Apr 08, no later than Oct 12)

/ / / /

* What percentage management stake do you have in the business?

Figures

Please attach audited accounts for 2012/13 with your application

* Please describe your disability

* As a disabled entrepreneur, what are some of the challenges you have faced and how have you overcome them? (200 words allowed)

* Please provide a brief description of your business, the products or services it supplies, its customers and the markets in which you operate, and how you run the business (200 words allowed)

* Please outline the overall trend in your sales turnover and profit development, together with a brief description of key strategies that have led to these changes

Consider the following: marketing, workforce development, customer recruitment and retention, environmental impact, financial planning and control, supplier relationships and management, operations, IT, and innovations (500 words allowed)

* What are your objectives for the business over the next 3 years and how would winning £50k help you achieve them? (200 words allowed)

* Is your business currently involved in any court cases?

Yes No

* Please confirm that all of the information in this application form is true and accurate

Yes No

* Please confirm that you have attached your audited accounts for 2012/13

Yes No

If you have any other attachments to support your application, please include them

(max. 2 MB)

Thank you for completing the application form.

Please email it, along with a copy of your audited accounts, to or send it in the post before the deadline of 5pm on 25th October 2013 to:

Strategic Partnerships & Innovative Services

Leonard Cheshire Disability

66 South Lambeth Road

London SW8 1RL

We will contact you in November to let you know if your application is successful.

Good luck!