Accessibility Awards Nomination Form

Personal information submitted on this form is being collected under the Municipal Act, 2001 by The Corporation of the City of Stratford and will be used to gather information related to nominations for the acessibility award. Questions about the use and collection of personal information are to be directed to the City Clerk, City Hall, P.O. Box 818, Stratford ON N5A 6W1 or by telephoning 519-271-0250 ext. 329 during business hours.

If you require this document in an alternate format, please contact City Hall at 519-271-0250 ext. 237 or e-mail Clerks office.

Select Nomination Category:

Community Member

Community Group or Not-For-Profit Organization

Business

Award Candidate/Nominee Information

Nominee Name:

Nominee Address:

Nominee Phone Number:

Nominee Email:

Has the individual or organization received an Accessibility Award in the past?

Yes

No

Not sure

Nominee achievements and contributions

Recognition Category

Preventing and/or removal of barriers

Accommodating persons with disabilities

Acting as an accessibility ambassador

Providing employment support for persons with disabilities

Providing exemplary accessible customer service

Contributing to persons with disabilities living independently

Explain in detail the nominee’s achievements and contributions:

Nominator Information

Nominator Name:

Nominator Address:

Nominator Phone Number:

Nominator Email: