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The Trust welcomes nominations from persons of any age (16 or over), race, colour, religious belief, ethnic or national origin, sexual orientation, gender, disability or marital status.

Help completing this form
Reference documents including downloadable versions of this form are available on the right of this page. Please do read the guide to preparing your election statement.

If you require any further information or assistance to complete this nomination form, or if you require the form in large print, Braille, audio or another language, please contact Ciara Norris at Electoral Reform Services (ERS) on 020 8365 8909 or email ciara.norris@electoralreform.co.uk

If you are experiencing any technical issues with this online form please contact Kevin Jacob - kevin.jacob@fhft.nhs.uk

Criteria: To be eligible to stand for election
Before you proceed, you must first of all check that you meet the following criteria:
1. Be a member of the Frimley Health NHS Foundation Trust
2. Belong to the constituency you wish to represent
3. Be willing to declare your political and financial interests

Your details

Please note: Your home address, telephone number and email address are for the sole use of ERS and the Trust so they can contact you should they need to. This information will remain confidential unless the Trust is required to release it by law.

Your election statement: Why you would like to be a Governor

Your election statement, describing why you think you should be elected, will be circulated to voters as part of the election statement booklet accompanying the ballot paper. Before you start writing your statement, we recommend that you read the ‘preparing your election statement’ document. Your statement will be reproduced word for word so remember to read it through carefully and check for any mistakes before you submit it.

You can copy and paste your statement into this box if desired. The box will provide a scroll bar for viewing the full text.

Declaration

I, the above named candidate, consent to my nomination and agree to stand for election to the Council of Governors in the constituency indicated on page 3 of this form. I also declare that I belong to that constituency.

I, the above named candidate, hereby declare that I am not:

a) a person who has been adjudged bankrupt or whose estate has been sequestrated and (in either case) has not been discharged

b) a person who has made a composition or arrangement with, or granted a trust deed for, his creditors and has not been discharged in respect of it

c) a person who within the preceding five years has been convicted in the British Islands of any offence if a sentence of imprisonment (whether suspended or not) for a period of not less than three months (without the option of a fine) was imposed on him

d) excluded by any other provision detailed within the Trust’s constitution.

By typing my name here I confirm that, to the best of my knowledge, the information provided on (or in connection with) this form is accurate.

Your constituency







Your photograph

You are invited to submit a photograph of yourself, to be published alongside your statement in the election statement booklet. While you are welcome not to submit one, providing a photograph can help voters to identify you. Be sure to name the file with your name.

Declaration of interests

Please note: Where you have answered no, the word ‘none’ will be published as your answer.

Are you a member of a political party?


If you have entered yes, please let us know which one
Do you have any financial or other interest in the Trust?


If you have answered yes, please let us know what your interest is

Close of nominations

After you have completed all sections of your nomination form, simply click submit below.

Please ensure it is received by the Returning Officer, Electoral Reform Services Limited no later than 5PM on Monday 4 September 2017. It won’t be possible for you to stand in this election if your nomination form is received after this time.

All nomination forms received will be acknowledged by the Returning Officer, Electoral Reform Services Limited within 24 hours, to the email address provided in this form. If you have not received your acknowledgement after this time, please contact Ciara Norris on 020 8365 8909 or email ciara.norris@electoralreform.co.uk to check that we have received your form.