Town of Prescott Committees & Boards Application

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Which Committee or Board are you applying for? (Select all that apply)

What are your skills and qualifications? (Please provide any relevant experience)

What are your interests and hobbies?

Are you a property owner or tenant (or a spouse of a property owner or tenant) in the Town of Prescott?

Are you 18 years of age or older?

Are you legally entitled to work in Canada?

Notice of Collection:

Personal information, as defined by the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA) is collected under the authority of the Municipal Act, 2011, and in accordance with the provisions of the MFIPPA. Personal information on this form will be used to assess the applicant's eligibility for volunteer positions or qualifications for appointment to any Town of Prescott Committees and Boards. At no time will your personal information be disclosed without your express written consent. Questions regrading the collection, use and disclosure of this personal information may be directed to the Freedom of Information Coordinator, Clerk's Office, 360 Dibble St West, Prescott, ON K0E 1T0, 613-925-2812.

Declaration: