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CAN Collaborator Organization Expression of Interest
Step
1
of
5
20%
Organization Name
City
Province/Territory
Which sector/s do you represent?
Agriculture
Construction and Mining
Crown Corporation
Education – Elementary
Education – Secondary
Education – Post-Secondary
Finance, Insurance and Real Estate
Government – Federal
Government – Municipal
Government – Provincial
Healthcare
Manufacturing
Not-For-Profit/NGO
Services
Trades
Transportation/Other Public Utilities
Other
Select all that apply.
Organization Website
Organization Twitter
Organization LinkedIn
Name
First
Last
Title/Role
City
Province/Territory
Email
Phone Number
Personal Twitter
Personal LinkedIn
Please indicate your functional ability in both official languages.
English (speaking)
English (writing)
French (speaking)
French (writing)
Do you identify as Indigenous [First Nations (North American Indians), Métis, or Inuit]?
Yes
No
Prefer not to answer
Do you identify as having lived experience of disability?
Yes
No
Prefer not to answer
Do you identify as a member of a visible minority in Canada?
Yes
No
Prefer not to answer
Please identify the pronouns you wish to be addressed using.
he/him
she/her
they/them
ze/zim
Other
Do you require any form of accommodation to participate fully in meetings and/or events?
Do you have any dietary requirements?
Would you like to participate in a CAN Community of Practice?
Education and Training
Employment
Policy
Research, Innovation and Design
Select all of the communities for which you would like to participate in.
Will you be your organization's representative on the CAN Advisory Council?
Yes
No
To be determined
Multiple individuals from the same organization may attend the CAN Advisory Council but only one representative may be a voting member.
Representative Name
First
Last
Representative Title/Role
Representative Email
Representative Phone Number
Please explain why your organization would like to become a CAN Collaborator Organization.
I understand that by submitting this Expression of Interest to become a CAN Collaborator Organization, and upon its approval, my organization is accepting the opportunity to collaborate and engage with the Canadian Accessibility Network and its collective community.
(Required)
I understand the above.
I understand that the role of our organization's designated representative on the Advisory Council is to take part in the national conversation during each of the formally scheduled meetings that take place a minimum of three times per year for approximately two hours each. Any obligation to engage outside of these formally scheduled meetings is optional but encouraged.
(Required)
I understand the above.
I understand that our organization will be identified as a CAN Collaborator Organization on the CAN website and as such, will be asked to provide access to our organization's official business logo. In addition, our organization and/or the organization's CAN Advisory Council representative could be featured in highlights of CAN activities, research and/or social media pending permission in advance to do so.
(Required)
I understand the above.
By submitting this application, we agree that the organization is committed to advancing accessibility for persons with disabilities and acknowledge that we are ready to and/or are actively pursuing equity, diversity and inclusion in our business practices.
(Required)
I understand the above.
I understand that this is a non-binding agreement and our organization can withdraw as a CAN Collaborator Organization by providing written notification to the CAN National Office at
[email protected]
at least 30 days in advance of termination to allow for appropriate time to finalize any outstanding collaborations.
(Required)
I understand the above.
I understand that CAN is subject to the policies of Carleton University and the laws applicable to universities in Ontario, including the Freedom of Information and Protection of Privacy Act, which may, in some cases, require the University to disclose information shared with CAN by a CAN Collaborator Organization.
(Required)
I understand the above.
Applicant's typed signature (please type your full name)
Date
MM slash DD slash YYYY
