Required fields are marked with asterisks (*)

Town and Gown Committee volunteer application

The Town and Gown Committee is a City of Kitchener municipal committee that brings together municipal staff and service providers, colleges and universities, students and community members to discuss community issues.

City of Kitchener residents are welcome to sit on the committee as a volunteer in a member-at-large or landlord role. In order to be eligible, applicants must live in Kitchener and be over 18 years of age.

Kitchener residents interested in volunteering on the committee may apply using the following application form.

Contact information

First name

Last name

Street address

City

Province

Postal code

Phone number

Email address

Applicant details

Which role are you applying for?

Member-at-large

Landlord

Why are you interested in joining the committee?

What is your perspective on the relationship between the City of Kitchener and post-secondary institutions?

What are you hoping to contribute to this committee if you are selected as a member?

Describe any relevant volunteer or work experience that will inform your work in the role.

Upload a document describing your prior work or volunteer experience (optional).

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Allowed extensions pdf, doc, docx

Do you have any anticipated conflicts of interest that would impact your work in this role?

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 assess applications for volunteer roles on the City of Kitchener's Town and Gown Committee. 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 Angela Henriquez, Administrative Assistant for Kitchener Bylaw Enforcement, at 519-783-8515 or by email at Angela.Henriquez@kitchener.ca.