Form Builder

Required fields are marked with asterisks (*)

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

Nominator Information

Nominee Information

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.

Please attach supporting documents for the application, if applicable.


Allowed extensions pdf, jpg, jpeg


Allowed extensions pdf, jpg, jpeg


Allowed extensions pdf, jpg, jpeg

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

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

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

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

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 concerning your service request/inquiry to the City of Brantford. Questions about this collection should be directed to:

Brantford City Hall
100 Wellington Square
Brantford, ON N3T 2M2
Telephone: 519-759-4150