Award of Merit for Barrier-Free Access Nomination Form

Please enter the name of the business or public space being nominated.

Please enter the location of the business or public space.

Please enter the contact name for the nominee.

Please enter the nominee's mailing address.

Please enter a phone number for the nominee.

Please enter the nominee's email address.

Please enter your first and last name.

Please enter your mailing address.

Please enter a phone number where we can reach you.

Please enter your email address.

Please describe the accessibility features of the business or public space.

Please describe how the nominee has demonstrated a commitment to accessibility.

Please describe the impact on the community.

Optional. Add any further information that supports this nomination.

Please type your name as a signature for this nomination.

Please enter today's date.