ALL FIELDS MARKED WITH A * ARE REQUIRED ENTRIES
NOMINATION FORM FOR ISLE OF WIGHT COUNCIL APPOINTED GOVERNORS
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NOMINATION FORM FOR ISLE OF WIGHT COUNCIL APPOINTED GOVERNORS
This form should be completed by any person interested in applying to become a governor.
Your Details
Title
---
Mrs
Mr
Miss
Ms
Sir
Lord
Lady
Dr
Prof
Rev
Other
other title
(please specify)
*
Forename
Middlename/Initials
*
Surname
*
Building/house name/number
*
Street address
*
Town Name
County
*
Postcode
Tel Number
(include area code)
Email address
Date of Birth
----
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Year
---
Jan
Feb
March
April
May
June
July
Aug
Sep
Oct
Nov
Dec
Month
----
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please note your Date of Birth is only required for the List 99 check.
List 99 is the list of teachers or workers prohibited or restricted from working with children or young people.
You will not be allowed to be a governer if you are on this list.
Fields marked '*' are required entries.
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