Freedom of Information Request Form

Request Information

Request for Access to general records
Access to own personal information
Correction to own personal information

Preferred format Paper copy
Electronic (secured PDF)
Compact disc

Preferred method of access to records Examine original
Receive copy

* Description of information or records you wish to access
Provide, in as much detail as possible. If you are requesting access to or correction of your personal information, identify the program or service which originally collected the personal information.

Your Information

* First name

* Last name

* Address

* City

* Province Provinces... Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Northwest Territories Nunavut Yukon

* Postal Code

* Phone
xxx-xxx-xxxx

* Email

Billing Information

Provide the information below as it appears on your credit card.

Billing info is the same as contact information

* First Name

* Last Name

* Address

* City

* State or Province Provinces... Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Northwest Territories Nunavut Yukon States... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

* Postal / Zip Code
xxx xxx / xxxxx

* Country Select one... Canada United States

* Phone
xxx-xxx-xxxx

* Email

Mailing Information

Mailing information is the same as billing information

Note: Mailing information must be within Niagara.

Consent

* I consent to the use of the information provided here and for the purpose of contacting me with regards to this request

* I understand that I can withdraw my consent at any time by notifying Niagara Region

Notice of Collection

Any personal information or personal health information submitted will be collected, used, and disclosed, where applicable, by members of Regional staff according to the Municipal Freedom of Information and Protection of Privacy Act or the Personal Health Information Protection Act. Any information you share will only be used for the intended purpose for which it was provided.

For questions or comments about privacy practices, or for more information about the administration of the Municipal Freedom of Information and Protection of Privacy Act in Niagara Region programs, see Freedom of Information and Open Government.