The Corporation of the County of Bruce
Accessibility Request Form
Documents in Alternate Formats
Personal Information (Please print.)
Name: ___________________________________________________
Address: _________________________________________________
Home phone number: _______________________________________
Cell phone number: _________________________________________
Email address: _____________________________________________
Document Information
Name of Document: _________________________________________
Department: _______________________________________________
Event (if applicable): _________________________________________
Which format would you prefer? (Check appropriate box.)
□ Large Print
Preferred font size: __________________________
Preferred font style: _________________________
□ Braille
□ Plain Language
□ Audio
□ Electronic (Check preferred format.)
□ Microsoft Word □ HTML □ Rich Text □ PDF
□ American Sign Language (ASL) / Langue des Signes Québécoises (LSQ)
□ Other: __________________________________________
Continued on back.
Date: ______________________________________
Signature: __________________________________
Thank you for your request. This form will be forwarded to the Deputy Clerk for follow-up.
The County of Bruce is committed to creating and maintaining an inclusive and accessible
community for all residents.
For any further questions or concerns, contact the Deputy Clerk at 519-881-1291, ext. 310
or email dvanwyck@brucecounty.on.ca