This is a Word document form to be edited and returned to us by email. 

It may not be fully accessible to assistive technologies (like a screen reader). 

If you use assistive technology and need versions of this document in a more accessible format, please send an email to to It will help us if you say what assistive technology you use and what format you prefer.

Local list nomination form 251.5KB DOCUMENT Published 19 October 2020