Required fields are marked with asterisks (*)

Delegation Request Form

This form must be completed and submitted to the Clerk of the Town of Essex by all persons wishing to address Council at a scheduled meeting of Council. Delegation requests must be submitted by 2:00 p.m. on the Tuesday prior to the scheduled meeting.

Any person who wishes to appear before Council as a Delegation on a matter that relates specifically to a matter contained in the Regular Council Meeting Agenda shall submit a Delegation Request Form no later than 4:30 PM on the Friday immediately preceding the date of the Regular Council Meeting. The Clerk shall have the sole authority to determine if the subject matter does in fact relate specifically to a matter contained in the Regular Council Meeting Agenda for purposes of allowing or denying the Delegation and the Clerk will introduce such Delegation Request Form(s) at the time of adopting the Published Agenda.

Presentations to Council are limited to 5 minutes per person to a maximum of 10 minutes for a group of two persons or more.

Personal information that you provide on this form is collected pursuant to the Municipal Freedom of Information and Protection of Privacy Act and will be used for the purpose of responding to your request. Please note that this form, if approved, will appear in the published Council Agenda and may be included in the Council Meeting minutes, both of which become part of the public record and are posted on our municipal website.

Delegates are responsible for indicating when an accommodation is required. The Clerk will determine the best method to address the accommodation in consultation with the individual in advance of the meeting.

First Name

Last Name

Date of meeting you wish to attend

Will you be attending in-person or virtually?

In-Person

Virtually

Are you representing a group?

Yes

Provide details on the issue(s) you wish to present to Council and any actions you will be asking Council to take.

Is this item on the agenda?

Yes

I don't know

Have you consulted with Administration on this issue?

Yes

Have you consulted with a Member of Council on this issue?

Yes

If you've consulted with Administration or Council, please provide the names of the individuals you've talked to and the details of those discussions.

If this is a property matter, are you an owner?

Yes

Not applicable

Have you appeared before Council in the past regarding this issue?

Yes

Presentation Materials

*Presentation materials will not be considered for presentation at the meeting unless they are attached to this form.

Will you have presentation materials? Any materials must be provided to the Clerk with this delegation request for review, approval, and circulation to Council and Administration. Materials will be made public.

Yes

Your Address or Group Contact Address (full mailing address including postal code)

Your Phone Numbers

Home

Work

Cell

Email Address *Required if joining virtually.

Name and address of all representatives attending, including their positions

Privacy Statement

Town Council and Committee meetings may be broadcast live via YouTube and Delegates will be included in the recording. Be advised that all Council and Committee meeting presentations become part of the public record and any presenters and their presentation materials will be disclosed on the public Agenda and Minutes of the meeting. Agendas and Minutes are published online, so the listing of any name and other information in connection with the Agenda or Minutes may be indexed by search engines like Google. Further, personal information contained in your Delegation, including this request and any presentation and materials related thereto, will be collected, used and disclosed by the Town for the purposes of holding and recording the applicable meeting. By making this Delegation Request and providing information related to the Delegation, you acknowledge and agree that you have obtained and are providing to the Town the consent required by the Town under the of the Municipal Act, 2001, as amended, to use, collect and disclose all of the personal information included in and related to your Delegation. Furthermore, any personal information you disclose in your correspondence will be used to receive your views on any relevant issue to enable Town of Essex Council to make decisions on matters before them and may be disclosed to the public. Questions about the use, collection and disclosure by the Town of personal information can be directed to the Legal and Legislative Services Department at clerks@essex.ca.

I have read and understand the above Privacy Statement.

Yes

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Delegation Request Form

Presentation Materials