Screening request form

Request a screening review

If you disagree with a ticket, you can request a review from a screening officer within 30 days of getting the ticket. Before you start:

• Do not pay the ticket if you're requesting a review
• You must submit a separate request for each ticket you want reviewed.
• You will get a confirmation email when you submit your request
• You will receive the decision by email or mail.

Request an extension

If you cannot address your ticket within 30 days of the incident, you can request an extension. We will only grant an extension if there are extenuating circumstances.

Request support 

Contact the city at 519-741-2345, TTY  1-866-969-9994 

Email screening@kitchener.ca if you have any questions or need:

• accessibility accommodations
• translation
• help filling out the form or don't have reliable access to a computer or the internet

Notice of collection

Personal information is being collected under the authority of s.11(1) of the Municipal Act and in accordance
with s. 28(2) of the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA) and will be
used to complete your screening review. This information will be shared with staff who
require it for their work as part of their work at the City of Kitchener and will be stored on a server owned by a
Third Party Service Provider (GHD Group) located in Canada. The personal information collected herein will
be used only for the purposes relating to the program and will be protected in accordance with the
requirements stipulated in the MFIPPA.

Inquiries about the collection, use or disclosure of your personal information should be directed
to By-Law Enforcement at screening@kitchener.ca or 519-741-2345.

Online Screening Application

Required fields are marked with asterisks (*)

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