Petition & Delegation Request Form - Jackie Powell

TOWN OF VIEW ROYAL PETITION & DELEGATION REQUEST FORM

Completed Petition & Delegation Request Form for Connections Place Society

Before completing this form, please refer to the Petition & Delegation Information Package

Request to appear on:

Year: 2018
Month: April
Day: 3rd or 17th

[x] Council [ ] Committee of the Whole

Anyone wishing to be placed on an agenda to address Council or Committee of the Whole may apply by delivering a request in writing to the Corporate Officer by 12:00 noon on the Thursday preceding the meeting date by completing this application form. Council meetings are held on the 1st and 3rd Tuesdays of the month with the exception of August; and only the 1st Tuesday of the month in December.

Each delegation is limited to fifteen (15) minutes unless extended or reduced by unanimous resolution of Council members present.

Date: March 7, 2018 Email: jackie.powell@connectionsplace.org Name of Applicant: Jackie Powell On Behalf of: Connections Place Society (Organization, Business, Self, etc.)

Mailing Address: c/o 2063 Renfrew Rd. Victoria Bc V8P 1S3 Local Street Address: Tel #: 250-812-0922 Fax: 250-598-7539

Details of Presentation: Introduction of the 'Clubhouse Model'. We are working to establish this world renowned model of psychosocial rehabilitation in the GVA. Specifically for people struggling with their mental illness. Scientifically proven to reduce emergency interventions (policing, hospitalizations etc. Established 70 years ago in New York City - Fountain House - now 334 Clubhouse models world wide. www.connectionsplace.org (provide additional information as an attachment if required)

List any requested audio visual needs – please note all presentations must be submitted at the time of application: We have a YouTube video we would like to share. 10 min presentation ~ 4 min video.

NOTE: Council and Committee of the Whole meetings are public meetings. The information on this form will become part of the public record and will be made available to Council, staff, media and the public. The information on this form is collected in order to respond to your request to appear before Council. If you have any questions about the collection and use of this information, please contact the Corporate Officer. The agenda is posted on the public notice board at the Town Hall and complete agenda packages are available on the Town's website (www.viewroyal.ca) and are available for viewing at Town Hall.

Please return completed form to the attention of the Deputy Corporate Officer by fax to 250-727-9551, by email to info@viewroyal.ca or in person to View Royal Town Hall, 45 View Royal Avenue, Victoria, BC V9B 1A2