LGBTQ+ ROLE MODEL AWARD NOMINATION FORM

This nomination is for an LGBTQ+ individual within your sport who is highly visible as a role model and has made an outstanding contribution to raising awareness, advocating for, and promoting LGBTQ+ inclusion within their organisation.

The nominee has a strong record of advocating for and/or supporting athletes with diverse sexualities and/or genders in sport, and their impact on LGBTQ+ inclusion is recognised and acknowledged by others within their sport or club.

This award recognises the critical role that LGBTQ+ role models play in demonstrating and reinforcing inclusion within sport. The nominee must identify as a person with a diverse sexuality and/or gender to be eligible for this award.

This application can be completed and submitted between Monday, 11 January 2027 – Monday, 8 February 2027.

Nominee Contact Details

Please provide the details below exactly as you would like them to appear on Awards materials, including social media, website, announcements, publications, and trophies (where applicable).

Please review all information carefully before submitting. ACON's Pride Inclusion Programs will reproduce names and details exactly as submitted and cannot accept responsibility for any inaccuracies in the nomination form.

Name *

Pronouns *

Employer/Organisation Name *

Position Title *

Primary Contact Email *

Nominator Contact Details

Name *

Primary Contact Email *

Disclosure

Please confirm BOTH of the following: *

The nominee is aware of this nomination and has given you permission to proceed.The nominee consents for any images or information provided in this nomination to be used in Awards materials including social media, website, announcements, event program, and trophy (if applicable).

How to Complete Your Nomination

'Save and Complete Later' Function:

IMPORTANT: Use the 'Save and Complete Later' function as you complete your nomination. This function can be utilised throughout the year, as you prepare, review and complete.
This function allows you to return to your work without losing any work previously updated.
If you do not use this function, any changes or updates made may not be saved and work may be lost. Pride in Diversity will not be responsible for any work lost.
Upon clicking 'Save and Complete Later,' you will be sent a link to utilise to return and continue work on your nomination.

'Submit' Function:

Once you have completed and reviewed all work and areready to submit, you must click the 'Submit' button upon completion.
If you do not click 'Submit' upon completion, your nomination will not be accepted.
Do not click the 'Submit' function unless you are ready to formally complete and submit your nomination.

Placeholder Link Function:

Each time you click 'Save and Complete Later,'you will be sent an updated link to continue you work on your nomination. Any work done on an 'outdated' link will result in work being lost.
Any link provided to you and your organisation can only be utilised by those within your organisation.
If multiple people are working on a nomination for their organisation, they must share this correct link or all work will not be saved properly. Each placeholder link email will be sent to the person who is working on the nomination at time of saving.

Internal Advoacy

As a visible LGBTQ+ role model, the nominee has contributed to a culture of inclusion within the sport/organisation.

This may include but is not limited to:

speaking at internal events as a visible LGBTQ+ role model
posting regularly on internal social media channels
advocating for workplace inclusion training
volunteering at new employee inductions
advocating on behalf of fellow LGBTQ+ people and underrepresented groups within the community
other general advocacy and support for LGBTQ+ people and inclusion within sport

If you wish to provide evidence to support your response above, please do so here:

Browse

Only one attachment per field.

External Advocacy

As a visible LGBTQ+ role model, the nominee has represented our sport/organisation by contributing to LGBTQ+ workplace inclusion externally.

This may include but is not limited to:

speaking at external workplace inclusion related events as a visible LGBTQ+ role model
voicing advocacy and support for social inclusion issues impacting the LGBTQ+ community
advocating on behalf of under-represented groups within the LGBTQ+ community
participating in community-based events
communicating advocacy and support for LGBTQ+ in sport to the media
other general advocacy and support for LGBTQ+ people and inclusion within sport

If you wish to provide evidence to support your response above, please do so here:

Browse

Only one attachment per field.

References

Written references are required in support of the nomination. Please provide the written references below, along with the name and position title of each referee.

Please do not provide only contact details without including a written reference.

Please provide one reference in support of this nomination.

Referee Name

Position Title

Please provide a second reference in support of this nomination.

Referee Name

Position Title

Additional Work

Please identify any additional information, not covered previously that you would like to include in support of this nomination.

Title of Work

Answer

Title of Work

Answer

Title of Work

Answer

Title of Work

Answer

If you wish to provide evidence to support your responses above, please do so here:

Browse

Only one attachment per field.

Finalist / Winner Statement

In a short paragraph, explain why this nominee specifically deserves recognition in this category, highlighting their key achievements and impact on LGBTQ+ inclusion in sport. This statement will be used in Awards materials if the nominee is selected as a finalist or winner. *Should this nominee become the recipient of this award, this statement will be read at the Australian Pride in Sport Awards.

Nominee Photo

Please provide a clear hi-resolution image of the nominee. Should they be selected as a finalist or winner within the category, this image may be used in Awards materials including social media, website, announcements and during the Awards ceremony. *

Browse

Only one attachment per field. File should be at least 1MB and minimum 2000 × 2000 pixels. Please do not upload social media profile images downloaded from websites (such as LinkedIn), as these are too low resolution to be used in Awards materials.

Save and Complete Later