Current Page 1 Page 2 Preview Personal information on this form is collected under the authority of Section 31(c) of the Freedom of Information and Protection of Privacy Act and will be used for the purposes of assessing nominations and determining the recipient of the award. If you have any questions about this collection of personal information, you may contact the Innovation PEI Office by telephone at 1-800-563-3734 or by email at innovation@gov.pe.ca. Identification Enter nominator information in the fields below. First Name Middle Initial Last Name Address 1 Address 2 City, Town, or Community Province Postal Code For example: C1B 0X1 or 12345 Country Telephone Number For example 902-555-5555 Email Address Nominee Information In which category would you like to submit a nomination? - Select -Artist of the Year AwardGertie & Henry Purdy Emerging Visual Arts BursaryLeo Cheverie Cultural Connector of the Year AwardOrganization of the Year AwardPremier of PEI's Award for Stand-Out Project of the Year Organization Group, Collective, or Organization (if applicable) First Name Last Name Address City, Town, or Community Postal Code For example C1B 0X1 or 12345 Telephone Number For example 902-555-5555 Email Address Which gender(s) does the nominee most identify? Check all that apply. Man Woman Transgender Man Transgender Woman Transgender Non-Binary Two-Spirit Non-Binary Gender not listed, please specify Prefer not to answer Other, please specify. What are the nominee's preferred pronouns? Is the nominee an Indigenous person? - Select -YesNoPrefer not to say What Indigenous community is the nominee affiliated with? Is the nominee a person of colour? - Select -YesNoPrefer not to say Does the nominee have a disability or identify as a person living with a disability? - Select -YesNoNot surePrefer not to say Does the nominee identify as a member of the 2SLGBTQIA+ community? - Select -YesNoPrefer not to sayI would like to provide more information Please provide more information. Website (if applicable) Social Media Accounts (if applicable)