Form Builder

Alternative Format Request

The City of Brantford has established a process for receiving and responding to requests for alternative formats of City documents and information from persons with disabilities. Requests may be made in person by visiting any City facility, by telephone by calling 519-759-4150, or by email to accessibility@brantford.ca.

Date submitted

Submitted to

Personal Information

Name

Mailing Address

Telephone Number

E-Mail ID

Document Needed

Document title

Format Requested

Select a format

ASL Interpreter

Audio

Braille

Colour Contrast

Large Font

Other

The personal information that you have provided to us to enable us to respond to your inquiry for information in an alternative format will be used by staff for that purpose only. You will not be placed on any mailing list, nor will your information be released to any third party, except as authorized by law. The authority for obtaining this information from you complies with the Ontario Regulation 429/07 – Accessibility Standards for Customer Service of the Accessibility for Ontarians with Disabilities Act, S.O. 2005, Chapter 1. Questions about this collection should be directed to:

City of Brantford Municipal Accessibility Coordinator
City Hall, PO Box 818, Brantford, ON N3T 5R7
Phone: 519-759-4150
Email: accessibility@brantford.ca.