NOMINATION FORM

Are you nominating yourself or someone else?

Nominating myself (Slay)

Nominating someone else

Nominee's Name *

Note: This does not need to be legal name

First Name

Last Name

Which state/territory does the nominee reside in? *

Australian Capital Territory (ACT)

New South Wales (NSW)

Northern Territory (NT)

Queensland (QLD)

South Australia (SA)

Tasmania (TAS)

Victoria (VIC)

Western Australia (WA)

Where is the nominee located

Metro / Urban

Regional

Rural

Remote

Do you/the nominee identify as... *

(Pick as many as you like)

Lesbian

Gay

Bisexual

Transgender

Queer

Intersex

Asexual

Aromantic

Pansexual

Nonbinary

Genderqueer

Genderfluid

Sistergirl

Brotherboy

Other

Prefer not to say

Do you/the nominee identify as an Aboriginal and/or Torres Strait Islander? *

Yes

No

Prefer not to say

Do you /the nominee identify as being from a Culturally and/or Linguistically Diverse Background? *

Yes

No

Prefer not to say

Do you /the nominee identify as a person living with a disability? *

Yes

No

Prefer not to say

Do you /the nominee have any neurodivergence? *

Note: Neurodivergent is a term that describes people whose brains develop or work differently for some reason. This means the person has different strengths and struggles from people whose brains develop or work more typically

Yes

No

Prefer not to say

If you're nominating yourself, you consent to your name and photo being shared on Wear it Purple Instagram. *

If you're nominating someone else, we will be reaching out to them in the following days to get their consent and a photo of them if they were to win.

I agree