Town of Stratford Volunteer Form

First Name:    Last Name:    Telephone: 

Address:    Community:    Postal Code: 

Email Address: 


Please list any knowledge, skills and experience (professional and/or personal) that may be beneficial for serving on a Town of Stratford committee:

Committee Choices
Is there a particular committee(s) you are interested in joining?   Yes    No 
If yes, please specify:  Choice #1 
                   Choice #2 
If you have identified specific committee choice(s) above, would you consider another committee outside of these selections (otherwise leave both selections blank)?  Yes    No 

Your voluntary response to the following diversity questions will assist us in determining whether the Town of Stratford committees are representative of the diverse residents we serve. The information is confidential and only used for statistical and diversity representation purposes. 

Are you: Male    Female    Transgender, non-binary, two-spirit    Prefer not to answer 

Age Range: 12-18 years    19-30 years    31-50 years    51-65 years    +65 years 

Do you identify as a person with a disability?  Yes    No 

What is your first language? English    French    Other (please specify): 

Are you proficient in other language(s)?  Yes    No 
   If yes, please specify all: 

Do you identify yourself as a minority or under-represented group?  Yes    No 

Other Questions: 

Over the next two years, there are may be other opportunities to volunteer with the Town of Stratford on a one-time or short term basis. These may include things like special events, focus groups, or topic specific work. Would you be interested in being contacted to participate in other volunteer opportunities if/as they arise?  Yes    No 


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