Access and Inclusion Advisory Group Nomination Form

Access and Inclusion Advisory Group – Nomination Form

First name:

Last name:

Given name:

Home address

Phone:

Email:

Preferred method of contact (Mobile/Phone/Post):

Selection Criteria

1. Please tell us a bit about yourself including whether you have a disability and the nature of that disability, care for someone with disability or are passionate about universal access and inclusion

2. Please outline the reasons for your interest in joining the Access and Inclusion Advisory Group

3. Do you live in the City of Perth? If not, how often do you visit the City and what is generally the purpose of your visit?

4. If you are a member of any other committees, working groups or organisations please provide details below:

5. Please outline your availability for meetings e.g. suitable days and times.

6. Do you have any other comments that you would like to make regarding your nomination for the City’s Access and Inclusion Advisory Group?

Please submit your completed nomination form by 5pm on Friday, 19 February 2021.

If you have any questions in relation to the City’s Access and Inclusion Advisory Group. Please contact the Jen Walsh via email: jen.walsh@cityofperth.wa.gov.au

or phone: (08) 9461 3145 .

I would like to receive updates on City of Perth's Access and Inclusion Advisory Group

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Access and Inclusion Advisory Group – Nomination Form

Selection Criteria

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