Lived Experience Impact Award

WA Mental Health Awards 2026 - Nomination Form

The Lived Experience Impact Award recognises an outstanding contribution to mental health in WA, by an individual who identifies as having a lived or living experience of a mental health challenge or suicide (as a consumer, carer or family member).

The successful nominee is able to demonstrate how they have improved the lives and wellbeing of others in the community and/or raised awareness of mental health challenges in WA.

Submitting a nomination for the Lived Experience Impact Award

Nominations for this award are open to any individual who identifies as having lived experience of a mental health challenge, or is a family member or carer of someone who identifies in this way. Self-nominations are not accepted for this category.

Please address the following questions in a separate document and upload as an attachment to this form:

Please describe the nominee's mental health journey.
Please demonstrate how the nominee has contributed to the mental wellbeing of Western Australians and/or raised awareness of mental ill-health in WA.
Please provide details of any specific achievements or positive changes as a result of the nominee's work, advocacy or lived experience.

The written response to the above questions should not exceed 2,500 words, excluding supporting documents or images.

For more tips on submitting a nomination, as well as a full list of nomination conditions, please view the Nomination Guide.

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* 1. Your name (person submitting the nomination)

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* 2. Your organisation or business name (if applicable)

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* 3. Your address

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* 4. Your phone number

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* 5. Your email address

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* 6. Nominee's name

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* 7. Nominee's phone number

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* 8. Nominee's email address

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* 9. What is your relationship to the nominee?

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* 10. Please provide some introductory information about the nominee.

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* 11. Why have you chosen to nominate this person for the 2026 Lived Experience Impact Award?

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* 12. Name of Referee 1

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* 13. Relationship of referee to nominee?

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* 14. Phone number for Referee 1

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* 15. Email address for Referee 1

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* 16. Name of Referee 2

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* 17. Relationship of referee to nominee?

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* 18. Phone number for Referee 2

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* 19. Email address for Referee 2

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* 20. Please upload your responses to the nomination questions above.