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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

Nominator Information

Please provide your contact details below

Nominee Information

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

Nominee mailing address

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

Award Category

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 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 or by phone at 519-759-4150.