Required fields are marked with asterisks (*)

Welcome

Committees play an important role in the municipal decision-making process and provide an opportunity for public engagement and participation.

First Name

Last Name

Phone Number

Street Address

City/Town

Postal Code

E-mail

Please select the Committee you are applying for.

If you have a second preference of a Committee to apply to please select that here.

If you have a third preference of a Committee to apply to please select that here.

Describe any specific knowledge or experience you have which relates to the Committee(s) in which you have expressed interest in.

Describe your experience serving on another board or committee (if applicable).

Please list any other community organizations that you are currently affiliated with.

If you are applying for the Accessibility Advisory Committee, please note that the Accessibility for Ontarians with Disabilities Act, 2005 requires that a majority of the committee members be persons with disabilities.

Do you identify as an individual with a disability?

Yes

Prefer not to identify

If you are applying to the Tillsonburg Airport Advisory Committee, do you identify as any of the following?

Tillsonburg Airport Commercial Tenant

Tillsonburg Airport Non-Commercial Tenant

Pilot

If appointed, are there any issues that you feel should be considered by the committee(s) you have selected?

Yes

The personal information on this form is collected under the authority of the Municipal Act, 2001, S.O. 2001, Chapter 25, as amended and is used solely for the purposes related to the appointment of citizens at large to Council Committees. If you are appointed to a Council Committee, your name may be viewed by the public. If you have any questions about the use of this information, please contact the Clerk's Office at 200 Broadway Street, 2nd Floor, Tillsonburg, ON N4G 5A7, by phone at (519) 688-3009 ext. 4041 or by email at clerks@tillsonburg.ca.