2017 PRIDE IN SPORT OUT ROLE MODELAWARD NOMINATION

This submission recognises the critical role that out role models play in sending a message of inclusion within sport. Your nominee needs to identify as Lesbian, Gay, Bisexual, Transgender, Gender Diverse or Intersex (or other community identifications) to qualify for this award and must be out and comfortable with their orientation, gender identity or intersex status being disclosed.

SUBMISSIONS MUST BE RECEIVED BY THE PRIDE IN SPORT TEAM NO LATER THAN 5PM AEST 24TH MARCH, 2017

Please send to:

orPride in Sport, 1st Floor, 414 Elizabeth Street, Surry Hills NSW 2010

orPride in Sport, PO Box 350, Darlinghurst NSW 1300

NOMINEE DETAILS

Name of person being nominated: / Please enter name as you would like it to appear on certificates or any awards if applicable
Sport: / Please enter name as you would like it to appear on certificates or any awards if applicable
Club: / Please enter name as you would like it to appear on certificates or any awards if applicable
Contact email for nominee:
Postal address for nominee:
Role in LGBTI inclusion: / Does the person you are nominating hold any formal role within any of your National or State Sporting Organisation’s LGBTI inclusion work?
Yes / No

VISIBILITY

What role does your nominee play within your sport
Please delete all that do not apply / Please select the closest descriptor to describe the position your nominee holds within the organisation
  • Player/Athlete
  • Administration
  • Volunteer
  • Coach
  • Official

How visible is your nominee as an ‘out’ person involved in sport
Please delete any that do not apply /
  • Out to the majority of people
  • Out to everyone
  • Out and very active / visible across the sport
  • Out and very active / visible externally
  • Out and very active / strong media profile as an LGBTI person

NOMINATION CONTACT DETAILS:

Contact Person for nomination:
/ Name:
Postal address:
Phone number:
Email:

DISCLOSURE

Please verify that the person you are nominating knows of the nomination and is happy for you to proceed: / Yes / No

Q1.1INTERNAL ADVOCACY OR IMPACT: Please add a new row for each unique area of contribution.

‘X’ in first column for each row that applies / Evidence provided in support of your response
(a) / Please identify how your nominee has contributed to your sports culture of inclusion as an out role model. / Please provide evidence.
Please indicate if you are sending this as an attachment along with the name of the attachment.
(b) / Please identify any internal events that your nominee has spoken at as an out role model for sport.
(c) / Please identify any activities that your nominee has been involved in to support current LGBTI players as an out role model for sport.
(d) / Please identify any internal communications, articles or opportunities that have featured your nominee as an out role model for sport.

Q2.1EXTERNAL ADVOCACY OR IMPACT: Please add a new row for each unique area of contribution.

‘X’ in first column for each row that applies / Evidence provided in support of your response
(a) / Please identify any impact that your nominee has had external to your club/team as an out role model. / Please provide evidence.
Please indicate if you are sending this as an attachment along with the name of the attachment.
(b ) / Please identify any events that your nominee has spoken at as an out role model for sport within the 2016 calendar year.
(c) / Please identify any activities that your nominee has been involved in to support young LGBTI people wishing to enter the sport within the 2016 calendar year.
(d) / Please identify any media that has profiled your nominee as an out role model for sport within the 2016 calendar year.
(e) / Please identify any support that has been shown by your nominee for LGBTI inclusion more generally in society. This may include participation in LGBTI community events.

Q3.1KEY REASONS FOR NOMINATION

‘X’ in first column for each row that applies
(a) / In one short paragraph, please articulate the most significant contribution that your nominee has made to LGBTI inclusion within sport within the 2016 calendar year and why you believe your nominee should be given this award.

Q4.1REFERENCES SUPPORTING NOMINATION

Please provide as many of the following references as you can in support of your nomination.

‘X’ in first column for each row that applies
(a) / Please provide a CEO or equivalent senior executive reference in support of this nomination.
(b) / Please provide one or more references from senior people within the club or sporting organisation to support this award.
(c) / Please provide one or more references from LGBTI players/team members in support of this award.
(d) / Please provide one or more external references in support of this nomination.
2017 PRIDE IN SPORT OUT ROLE MODEL AWARD Page | 1