Request Accessible Information or Communication

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Accessible Format or Communication Support Requests

Notice of Collection of Personal Information

Personal information on this form is collected under the legal authority of Municipal Act, 2001. The delegate’s information is collected and maintained for the purpose of creating a record that is available to the general public, pursuant to Section 27 of the Municipal Freedom of Information and Protection of Privacy Act. This information is collected and maintained for the purposes of preparing an agenda for Council. Questions or concerns about the collection of this information can be directed to the Clerk at 4305 Hamilton Road, Dorchester ON N0L 1G3, Phone: 519-268-7334 ext 254 or clerk@thamescentre.on.ca

Full name of Requestor

Date of Request

Street Number

Street Name

City/Town

Postal Code

Phone Number

Request Information in an accessible format (in English):

Name of Document

Department the document originated

Please include specifics related to format

Date of Support required

Location of Meeting