Required fields are marked with asterisks (*)

Freedom of information request form

Under the Freedom of Information and Protection of Privacy Act/Municipal Freedom of Information and Protection of Privacy Act

Note: A $5 application fee is required for all requests. To pay the application fee, please send a cheque payable to “City of Kitchener” to the attention of Monika Tomczyk at 200 King St. W., Kitchener, ON. Additional fees are due upon fulfillment of your request, in accordance with O.Reg 823.

Request for:

Access to general records

Access to own personal information

Correction to own personal information

Preferred method of access to records:

Examine original

Receive copy

Name of Institution request made to:

If request is for access to, or correction of, own personal information records:

Last name appearing on records:

Same as below

Other

First name

Middle name

Last name

Phone number

Extension

Email address

Mailing address

Postal code

Unit

Detailed description of requested records, personal information or personal information to be corrected.

(If you are requesting access to or correction of your personal information, please identify the personal information bank or record containing the person information, if known.)

Notice of Collection

Personal information is being collected in accordance with of s. 28(2) of the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA). The information you provide will be used to correspond with you regarding your request and will be accessible only to select staff who require it to respond to and fulfill your request. The information you provide on this form will be retained on a server owned by a Third Party Service Provider (eSolutions Group) located in Canada. Inquiries about the collection, use or disclosure of your personal information should be directed to Monika Tomczyk at Monika.Tomczyk@kitchener.ca or (519)741-2200 x 7766.

Land acknowledgement

The City of Kitchener is situated on the traditional territory of the Chonnonton, Anishinaabeg, and Haudenosaunee Peoples. We recognize our responsibility to act as stewards for the land and honour the original caretakers who came before us. Our community is enriched by the enduring knowledge and deep-rooted traditions of the diverse First Nations, Métis, and Inuit Peoples who live in Kitchener today.