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Township of Brock Accessibility Award Form

Complete the below form To nominate a deserving business, organization or individual for the Township of Brock Accessibility Award. Please include details of their efforts to improve accessibility and/or accessibility awareness, and how the nominee has gone above and beyond to make accessibility a key factor in the community. The business or organization must be located within the Township of Brock, and the individual must be a Brock resident.

The Township of Brock Accessibility Advisory Committee will review all nomination forms and select one winner based on the criteria of showing a concerted effort to improve accessibility. Improved accessibility can mean either physical alterations or new programs and features that reduce barriers to permit greater access to services for those with disabilities.

Nominee's Name (Business, Person or Organization):

Contact Person:

Nominee's Phone Number

Nominees Email Address

Nominee's Address / Website

Reason for Nomination:

Nominator's Name

Nominator's Phone Number:

Nominator's Email Address:

Confirmation

I hereby confirm that the information provided in this form is true, complete, and accurate to the best of my knowledge.

Forms

Township of Brock Accessibility Award Form