Applications are due by 4:00pm on Friday December 7 2018. Upon request this form can be made available in alternate formats or with communication supports. To submit a request please contact the Clerk’s Office by phone at 613- 968-6481 or in person at City Hall, 169 Front St. Belleville ON K8N 2Y8
*If you would like more space for your responses please use reverse side or attach additional sheets of paper
Under the Accessibility for Ontarians with Disabilities Act, 2005, the majority of members on an Accessibility Advisory Committee must be individuals with disabilities.
In order to ensure we can fulfill this requirement, we are asking that those who are comfortable please self-identify if you are an individual with a disability. (select one):
As much as possible, The City of Belleville is committed to ensuring our Accessibility Advisory Committee represents the diverse lived experiences of our community members.
Personal information provided on this form is collected under than authority of the Municipal Act SO 2001, c 25 and may be made public during the appointment process. Please contact the City Clerk’s Department with any questions about the collection of this personal information: 613-968-6481 or at City Hall, 169 Front St. Belleville, ON K8N 2Y8.
Please return completed form to the Clerk’s Office at City Hall, 169 Front St. Belleville ON K8N 2Y8” Please submit your application no later than 4:00pm on Friday December 7 2018.
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