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Accessibility Improvement Award Nomination Form

Accessible formats and communication supports available upon request. For more information please contact, the City of Brantford Accessibility Coordinator at accessibility@brantford.ca.

Nominator Information

Please provide your contact details below

First name

Last name

Phone number

Email address

Re-enter email address

Nominee Information

Please provide information about the person or organization you are nominating for an accessibility award

First name of nominee

Last name of nominee

Project name (if applicable)

Company/Organization (if applicable)

Nominee's phone number

Nominee's email

Re-enter nominee's email

Nominee mailing address

Nominee's street number

Nominee's street name

Nominee's unit number

Nominee's city

Nominee's postal code

Please include sufficient information to provide the selection committee with a comprehensive understanding of the contributions/improvements of the nominee, such as a project description and/or biographical information. The questions below will help guide you in providing meaningful information about your nominee. Please answer the questions that apply and provide any additional information or materials you feel are relevant to the selection process.

Nominee and/or project description

Please attach supporting documents for the application, if applicable.

Upload a Supporting Document

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Allowed extensions pdf, jpg, jpeg

Upload a Supporting Document

Browse…

Allowed extensions pdf, jpg, jpeg

Upload a Supporting Document

Browse…

Allowed extensions pdf, jpg, jpeg

Award Category

Customer Service (An organization, business and/or individual that demonstrates leadership in providing exceptional customer service to persons with disabilities.)

Transportation (An organization, business and/or individual that demonstrates leadership in advancing access to transportation for persons with disabilities.)

Information and Communication (An organization, business and/or individual that demonstrates leadership in providing information and communication supports to persons with disabilities.)

Employment (An organization, business and/or individual that provides meaningful employment opportunities and demonstrates flexible and respectful integration of people with disabilities into their workforce.)

Built Environment (A building, interior, exterior or outdoor space designed or renovated to eliminate barriers and/or enhance access for persons with disabilities.)

What makes this individual/organization/business a viable candidate for this award?

Please specify

In what way(s) does the individual/organization/business enhance or improve accessibility for persons with disabilities?

Please specify

Describe the impact that the individual/organization/business has on developing and delivering effective awareness about improving accessibility for persons with disabilities.

Please describe

If applicable, please describe an experience or interaction you had with the nominee(s) that demonstrated their commitment to improving accessibility.

Please describe

A copy of your completed form will be sent to the email address you provided.

Personal information on this form is collected under the authority of Section 10(1) of the Municipal Act, 2001, S.O. 2001, c.25, as amended and will be used to contact you and the person you have nominated concerning the City of Brantford’s accessibility improvement awards. Questions about this collection should be directed to the City of Brantford’s accessibility coordinator at accessibility@brantford.ca or by phone at 519-759-4150.