Required fields are marked with asterisks (*)

Municipal Property and Building Commemorative Naming Submission Form

Which City property or facility are you submitting a name for or renaming?

What name are you suggesting for this property or facility?

The name has geographic, civic or historic significance for the neighbourhood/community where it will be located.

False

True

The individual will have demonstrated excellence, courage or exceptional service to the citizens of the City of Guelph, the Province of Ontario or Canada.

False

True

The individual will have worked to foster equality and reduce discrimination

False

True

The individual will have risked or given his/her life to save or protect others

False

True

Where the individual is a current City employee, they will have made an outstanding contribution to the City of Guelph outside of their capacity and duties as a City employee or once they are no longer a City employee

False

True

Please use the space below to provide any further information.

Attach all supporting documentation before submitting the form.

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Applicant Information:

Name

Phone

Address

Email Address

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, 2001, and in accordance with the provisions of MFIPPA.

If you have questions about this collection; use, and disclosure of this information, contact the City of Guelph’s Access, Privacy and Records Specialist at 519-822-1260 extension 2349 or privacy@guelph.ca