RAAC Application Form

Full Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal Code
Email
example@example.com
Phone
Please indicate how you wish to be contacted:

PhoneEmail
What target group(s) do you represent? Select all that apply

A person with a visible or invisible disability; including but not limited to:PhysicalCognitivePerceptualMental Health DisabilitiesOther
A member of a disability-serving organization:
Organization Name:
A parent of guardian supporting someone with a disabilityA person with Indigneous backgroundA person from another equity-deserving groupA community member-at-large
Why do you want to be a part of this committee?
What related skills, knowledge, or experiences do you have that may benefit this committee?
What accessibility accommodations do you require, if any?
Completed applications are due by 4:00 pm on Monday, November 29, 2023 and may be submitted by email, mail or dropped off in-person:

Email: alund@rdck.bc.ca
Mail / In-person: Attention: Angela Lund, Box 590 202 Lakeside Drive, Nelson, BC, V1L 5R4

Freedom of Information and Protection of Privacy Act Collection Notice

Personal information collected by this form is authorized under the Freedom of Information and Protection of Privacy Act section 26 and will be used only for the purpose of appointing persons to a committee pursuant to section 218 of the Local Government Act.

If you have any questions about the collection and use of this information, please contact

Angela Lund, Deputy Corporate Officer,

Phone: 250.352.8160

Email: alund@rdck.bc.ca
Should be Empty: