Required fields are marked with asterisks (*)

Accessibility Advisory Committee Application

The primary mandate of the Essex Accessibility Advisory Committee is to consult with and provide advice to Council on the annual municipal accessibility plan for the Town of Essex.

Please note that submitting an Application does not guarantee appointment to the Committee.

The Term of Office for this Committee coincides with the Term of Office for Council and shall be from December 14, 2026 to November 14, 2030.

View the proposed Terms of Reference and learn more about the Accessibility Advisory Committee.

*All Committee Members will be required to attend one training session.

Privacy Statement: Personal information on this form is collected under the authority of the Municipal Act, 2001. This information is collected for the purpose of screening and appointing members to Committees and Local Board of Town of Essex Council. Questions about the collection of this information can be directed to the Deputy Clerk, Town of Essex, 33 Talbot Street South, Essex, ON, N8M 1A8. Telephone (519) 776-7336.

Applicant Information

Last Name or Single Name

First Name

Middle Name (if applicable)

Street Number

Street Name

Apartment/Unit/Level (if applicable)

Town

Postal Code

Email Address

Primary Phone Number

Availability (Check all that apply)

Daytime

Evening

Are you comfortable with committee meetings being livestreamed for public viewing?

Yes

Do you have access to electronic communication? (i.e., email)

Yes