Grand River Accessibility Advisory Committee Application Form

Background

Thank you for your interest in becoming a member of the Grand River Accessibility Advisory Committee (GRAAC). Applications are welcome until November 15, 2026. You can find the committee’s Terms of Reference here. Please read the following before completing the application form below.

Membership on the committee is open to:

People with disabilities
People supporting persons with disabilities, e.g. caregiver
Designated representative of an agency serving people with disabilities

A trusted family member, friend or support person may assist you with your application.

Accommodations and accessibility supports are available throughout recruitment and committee participation. If you require an accommodation, an alternative format or another way to apply (e.g. phone interview, ASL interview), please contact:

Haley Gienow-McConnell, Region of Waterloo
hgienowmcconnell@regionofwaterloo.ca

548-398-5439

Amy Ross, City of Waterloo
amy.ross@waterloo.ca

519-884-6294

How Members Will be Selected

Our goal is to establish a committee with a broad range of disability experiences, identities, perspectives and community knowledge. Another goal is to have members representing the 7 area municipalities served by the Region of Waterloo (Waterloo, Kitchener, Cambridge, North Dumfries, Wellesley, Wilmot, Woolwich).

Applications will be considered collectively rather than simply selecting applicants based on individual qualifications. Selection will consider the overall composition of the committee, including representation of different disability experiences, backgrounds, perspectives and areas of community knowledge.

The majority of GRAAC members will be people with disabilities.

To support a diversity of perspectives, no more than one member will represent the same agency serving people with disabilities.

Thank you for your interest in the committee. We are excited to learn more about you.

Privacy Statement

Personal information, as defined by Section 2(i) of 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. Personal information on this form will be used to assess applicants’ qualifications for appointment to one of the Region’s various committees or boards. Personal information may form part of meeting agendas and minutes and therefore may be made available to members of the public at the meetings, through requests, and through the website of the Regional Municipality of Waterloo and/or applicable Board. Questions regarding the collection, use, and disclosure of this personal information may be directed to the Regional Clerk’s Office.

Application Questions:

Preferred contact information, please choose at least one:

Your name:

Preferred Pronouns:

By email:

By phone:

1. What is your relationship to disability/accessibility?

2. Tell us about your interest in becoming a member of GRAAC.

3. Tell us a little bit about yourself/your organization so we can get to know you better. E.g. Are you a student? A parent? An older adult? A newcomer? Indigenous? A part of the 2SLGBTQIA+ community? Anything else you think is interesting and relevant.

4. Tell us about experience(s) you bring to GRAAC. Lived experience is valuable. Experience does not have to be formal, though it can be.

5. Tell us about ways you are or have been involved in your community.

Commitment

Membership on GRAAC is a responsibility. On average, members of GRAAC spend between 4-5 hours a month participating. This includes attending monthly meetings, reviewing materials to prepare for meetings, and travelling time to and from meetings, if you choose to attend in person. Regular attendance is expected.

7. Are you comfortable committing this amount of time?

Yes, I am comfortable committing this amount of time.

No, I am not comfortable committing this amount of time.

I am unsure if I can commit this amount of time.

8. Regular meetings will be held the third Thursday of every month from 12:30 pm – 2:00 pm. You may attend in person or virtually. Are you able to commit to this day and time?

Yes, I can commit to this day and time.

No, I cannot commit to this day and time.

I am unsure if I can commit to this day and time.

Demographic questions

The following questions are voluntary. You do not have to answer them. However, information provided here may inform our selection of applicants.

These demographic questions are being asked to better understand who is applying to GRAAC. This helps us build a committee that is diverse and includes many perspectives. It also helps us learn who we are reaching, and whose perspectives might be missing from the ways we engage with community. You may have already included some of this information in your answers above. Feel free to share it again here.

The information you provide here will be kept confidential, accessible only to Region of Waterloo and City of Waterloo staff. Any results published will be reported in aggregate form with no personal identifying information included. Personal information is collected in accordance with s. 28(2) of Municipal Freedom of Information and Protection of Privacy Act. (MFIPPA).

1. Are you a member of/do you identify with any of the following? Check all that apply.

Person with a disability

Indigenous (First Nations, Inuit or Métis)

Racialized

Newcomer

2SLGBTQ+ identified

Member of a minority faith-based community

None of the above

Prefer not to answer

2. Which age group do you belong to?

Under 18 years

18–29 years old

30–39 years old

40–49 years old

50–59 years old

60–64 years old

65 years and above

Prefer not to answer

3. What is your gender identity?

Woman

Trans woman

Man

Trans man

Non-binary

Gender Fluid /Gender Queer

Two-Spirit

Other

Prefer not to answer

Conflicts of Interest

Members of the public who are appointed to represent the Region of Waterloo must ensure that their personal interests do not interfere with their public duties as a committee member. A conflict of interest arises when your personal interests conflict, or are perceived to conflict, with the interests of the Region of Waterloo. You are required to disclose any personal interests that may conflict with the interests of this committee. Disclosure does not disqualify you from consideration for appointment.

1. Do you have any personal interests that may conflict with the interests of the position for which you are applying?

Yes

2. Please note that successful applicants will be expected to adhere to the Code of Conduct for Citizen Appointments to Local Boards, Foundations and Advisory Committees. If chosen as a successful applicant, do you agree to adhere to this Code of Conduct?

Yes

3. By selecting I agree you declare that the information in this application form is true and you understand that you may be asked to provide information to confirm your identity, eligibility, and qualifications.

I agree

I do not agree

4. I understand that if I am recommended for appointment, my name will be listed publicly on Region of Waterloo Council agendas and minutes which are posted publicly on regionofwaterloo.ca.

Yes

5. Please confirm the following: I am a property owner or resident of the Region of Waterloo, being 16 years of age or older, unless otherwise specified in the terms of reference of the advisory committee or special purpose body.

Yes, I am

No, I am not