230406 Recreation and Sports Advisory Committee AgendaPage 1 of 2
The Corporation of the Town of Tillsonburg
Recreation & Sports Advisory Committee
April 6, 2023
5:30 p.m.
Council Chambers
AGENDA
1. Call to Order
2. Adoption of Agenda
Proposed Resolution #1
Moved by:
Seconded by:
THAT the Agenda as prepared for the Recreation & Sports Advisory Committee
meeting of April 6, 2023, be approved.
3. Minutes of the Previous Meeting
4. Disclosures of Pecuniary Interest and the General Nature Thereof
5. General Business and Reports
5.1. Tillsonburg Minor Soccer Club
5.2. Hall of Fame
5.3. Recreation satisfaction survey
5.4. Commemorative naming policy
6. Next Meeting
[Date]
7. Adjournment
The meeting adjourned at _____ p.m.
Page 2 of 2
Please contact the Staff Liaison listed below to gain access to this electronic
meeting:
Contact
Margaret Puhr
mpuhr@tillsonburg.ca
519-688-3009 ext.4202
Revised by the Recreation & Sports Advisory Committee, May 2022
TILLSONBURG SPORTS HALL OF FAME
PURPOSE & CRITERIA
The Tillsonburg Sports Hall of Fame was proposed by the Recreation Advisory Committee and
adjunct of Tillsonburg Community Centre in October 2003.
1. PURPOSE
The purpose of the Tillsonburg Sports Hall of Fame is to provide recognition for those residents of
Tillsonburg who, were distinguished as being an exceptional athlete, member of exceptional team,
builder of sport and/or coach. Nominees may be past or present residents who have lived in the
area for a minimum of two years or, at the discretion of the nominating committee, non-residents
who have made significant contributions to sport in Tillsonburg.
Athletes shall not normally be considered for Induction until after a three year waiting period
following their retirement from major championship competition OR the performance of a particularly
outstanding achievement that warrants special recognition. Nominees must be a minimum age of 18
at the time of nomination. The Selection Committee may choose to waive this waiting period or age
requirement if they feel the athlete deserves immediate recognition.
2. CRITERIA
Individual Criteria
Must have participated successfully in amateur or professional sport, having performed in
such a way as an individual or member of a team, to bring special honour to Tillsonburg at a
provincial, national or international level.
Said athlete has represented a Tillsonburg team, school or organization.
Team Criteria
Must have attained a high level of excellence and brought honour to Tillsonburg sport at a
provincial, national or international level.
Teams are selected for achievement in one year only.
Coach Criteria
Has participated successfully as a coach in amateur or professional sport at a provincial,
national or international level, having performed in such a way as to bring special honour to
Tillsonburg.
Said coach must have, at time of achievement represented a Tillsonburg team.
Coach candidates may be either active or inactive at the time of their consideration.
Coaches who contribute to sport in Tillsonburg, whether or not the coach is a resident, will be
considered.
Builder Criteria
Must have attained a high level of excellence and brought recognition to Tillsonburg through
on-going dedication to the development of athletes, teams, or sport itself.
Said builder must have, at the time of the achievement represented a Tillsonburg sporting
body.
A builder can be defined as, but not limited to, an administrator, official, sponsor, executive
member, trainer, or volunteer worker.
Builder candidates may be either active or inactive at the time of their consideration.
Revised by the Recreation & Sports Advisory Committee, May 2022
Builder nominees who contribute to sport in Tillsonburg, whether or not the builder is a
resident, will be considered.
3. NOMINATION FORM
See attached sheets.
4. SELECTION COMMITTEE
The Selection Committee will consist of members of the Recreation Advisory Committee with
staff support from the Recreation, Culture & Parks Department. .
Should the Committee require outside expertise on the selection committee, they shall seek
Council approval to add a subcommittee of Council, with a clear mandate, terms of reference
and a process to select subcommittee members. All subcommittee members will need to be
approved by Council.
5. NUMBER OF INDUCTEES
In year one, the number of inductees will be open
In year two, inductees will be limited to three per category
Following year two, the number of inductees will be limited to a maximum number of:
Teams – 2
Individuals – 4
Coaches – 2
Builders – 2
In order to account for missing a bi-Annual event in 2021 due to public health restrictions, In
2023 the number of inductees will be limited to a maximum number of:
Teams – 4
Individuals – 8
Coaches – 4
Builders – 4
After the 2023 induction year, the number of inductees will be reduced to the maximum
number following year two as noted above.
Note: It is not necessary to have one inductee in each category per induction.
6. RECOGNITION
Inductees will be recognized in the following manner:
a. Bi-Annual induction ceremony, or upon need;
b. Press release of the event in the local newspaper; and,
c. Display of wall plaque with picture and bio for each inductee at the Tillsonburg
Community Centre.
7. ADMINISTRATION
Administration of the Tillsonburg Sports Hall of Fame, including record keeping and actual
site determination, will be provided by the Recreation Culture and Parks Department.
________________________________________________________________________________
Revised by the Recreation & Sports Advisory Committee, May 2022
INSTRUCTIONS:
1. All submissions must be accompanied by an appropriate photograph:
a. That is a 5 x 7 size;
b. That is of a good quality and suitable for reproduction; and,
c. In which all persons in team pictures are identified by name in order, left to right
sequence.
2. All research and information gathered is the responsibility of the nominator.
3. Attach all photocopies of articles from newspapers, etc., with names and dates if
possible.
4. Complete all pages of the nomination form. Please type or print clearly.
5. Mail or deliver completed form and all attachments to:
Tillsonburg Sports Hall of Fame
c/o Tillsonburg Community Centre
45 Hardy Ave.,
Tillsonburg, ON N4G 3W9
6. The deadline for all nominations is March 1 annually.
7. If the nomination is accepted, both nominator and nominee will be contacted directly.
8. Completed nomination forms not accepted will be kept and considered for a
maximum of 3 induction sessions following which a new form would have to be
submitted.
Revised by the Recreation & Sports Advisory Committee, May 2022
TILLSONBURG SPORTS HALL OF FAME
NOMINATION FORM
Date of Submission: Staff Received:
Name of Team: Sport:
Name of Individual: Sport:
Accomplishment:
Date:
Nominee’s Date of Birth:
__________________________________________________________________________________
Nominee’s Address Town/City Postal Code
__________________________________________________________________________________
Phone Business Phone Home Email
Other Information:
How long has the nominee lived in Tillsonburg?(for athlete nominees)
Name of Nominator(s):
___________________________________________________________________________________
Address: Town/City Postal Code
___________________________________________________________________________________
Phone Business Phone Home Email
Revised by the Recreation & Sports Advisory Committee, May 2022
Signature of Nominator
Date of Submission
If accepted, I give permission to the Town of Tillsonburg, Hall of Fame Selection Committee to copy the photograph submitted.
SUMMARY OF SPORTS CAREER
Dates, awards, records are important. Please give as much information as possible. A breakdown of
international, national, provincial and other accomplishments in chronological order is preferred. Please
include vital statistics (date of birth, and/or death, if applicable) and prepare the document in point -form
style
PERSONAL
INTERNATIONAL
NATIONAL
PROVINCIAL
Revised by the Recreation & Sports Advisory Committee, May 2022
OTHER
CHECKLIST FOR NOMINATOR AS PER INSTRUCTIONS:
1. All submissions must be accompanied by an appropriate photograph:
a. That is a 5 x 7 size;
b. That is of a good quality and suitable for reproduction; and,
c. In which all persons in team pictures are identified by name in order,
left to right sequence.
2. All research and information gathered is the responsibility of the nominator.
3. Attach all photocopies of articles from newspapers, etc., with names and
dates if possible.
4. Complete all pages of the nomination form. Please type or print clearly.
5. Mail or deliver completed form and all attachments to:
Tillsonburg Sports Hall of Fame
c/o Tillsonburg Community Centre
45 Hardy Ave.,
Tillsonburg, ON N4G 3W9
6. The deadline for all nominations is.
7. If the nomination is accepted, both nominator and nominee will be contacted
directly via telephone, email and/or letter.
8. Completed nomination forms not accepted will be kept and considered for a
maximum of 3 induction sessions following which a new form would have to
be submitted.
4/3/23, 2:08 PM Aquatics Program Satisfaction Survey
https://docs.google.com/forms/d/1iWw4gWjPBnzAFMwlfazQ9e32esC0hwA6Yo_d16fx1NY/viewanalytics 1/4
Please indicate which aquatic program you are providing feedback on:
31 responses
How satisfied were you with the overall program?
32 responses
Aquatics Program Satisfaction Survey
32 responses
Publish analytics
Copy
Bronze Star - Saturday @ 10:…
Guppy - Monday @ 9:30am
Parent and Tot 1 - Monday @…
Parent and Tot 1 - Friday @ 9…
Parent and Tot 2 - Monday @…
Parent and Tot 3 - Friday @ 1…
Pre-School 1 - Monday @ 10:…
Pre-School 1 - Monday @ 4:0…
1/6
Copy
1 2 3 4 5
0
5
10
15
20
0 (0%)0 (0%)0 (0%)1 (3.1%)1 (3.1%)1 (3.1%)5 (15.6%)
8 (25%)
18 (56.3%)
4/3/23, 2:08 PM Aquatics Program Satisfaction Survey
https://docs.google.com/forms/d/1iWw4gWjPBnzAFMwlfazQ9e32esC0hwA6Yo_d16fx1NY/viewanalytics 2/4
How satisfied were you with the facility?
32 responses
How satisfied were you with the quality of instruction?
32 responses
Copy
1 2 3 4 5
0
5
10
15
0 (0%)0 (0%)0 (0%)2 (6.3%)
11 (34.4%)
7 (21.9%)
12 (37.5%)
Copy
1 2 3 4 5
0
10
20
30
0 (0%)0 (0%)0 (0%)1 (3.1%)1 (3.1%)1 (3.1%)4 (12.5%)
6 (18.8%)
21 (65.6%)
4/3/23, 2:06 PM Recreation Program Satisfaction Survey
https://docs.google.com/forms/d/1T5BWiDdRz4wRAGzGFmSiDssYMlBCF9uE4aJSyWc-wbo/viewanalytics 1/6
Please indicate which recreation program you are providing feedback on:
51 responses
How satisfied were you with the overall program?
51 responses
Recreation Program Satisfaction Survey
51 responses
Publish analytics
Copy
Active Learn 1
Active Learn 2
Badminton
Beginner Dance
Beginner Gymnastics - Wedn…
Beginner Gymnastics - Thurs…
Creation Series - Advanced C…
Creation Series - Beginner C…
1/4
9.8%
9.8%
9.8%
Copy
1 2 3 4 5
0
10
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30
40
1 (2%)1 (2%)1 (2%)0 (0%)0 (0%)0 (0%)4 (7.8%)
15 (29.4%)
31 (60.8%)
4/3/23, 2:06 PM Recreation Program Satisfaction Survey
https://docs.google.com/forms/d/1T5BWiDdRz4wRAGzGFmSiDssYMlBCF9uE4aJSyWc-wbo/viewanalytics 2/6
How satisfied were you with the facility?
51 responses
How satisfied were you with the quality of instruction?
51 responses
Copy
1 2 3 4 5
0
10
20
30
40
0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)1 (2%)1 (2%)1 (2%)
16 (31.4%)
34 (66.7%)
Copy
1 2 3 4 5
0
10
20
30
40
1 (2%)1 (2%)1 (2%)0 (0%)0 (0%)0 (0%)6 (11.8%)
10 (19.6%)
34 (66.7%)
Page 1 of 19
RECREATION, HERITAGE AND PARKS
Policy 9 -006: Commemorative Naming Policy
Approval Date: April 25, 2016
Approval Authority: Council, By-Law 4012
Effective Date: April 25, 2016
Next Scheduled Review Year:
Department: Recreation, Culture and Parks
Last reviewed: April 25, 2016
Revision Date/s:
Schedules:
POLICY STATEMENT
The Town of Tillsonburg is committed to providing a fair, consistent and efficient process
with respect to the commemorative naming of municipal assets, after a person, persons or
family name.
PURPOSE
The purpose of this policy is to provide clear guidelines, a consistent evaluation framework
and approval process in regards to the Commemorative Naming or Renaming of Town
assets and to allow for comprehensive and open public consultation in accordance with
the Town’s Public Engagement Policy.
Such a process will ensure the application of key criteria in order to determine the
appropriateness of a name and shall recognize the important role played by the legislative
bodies involved (i.e. Committees and Council).
SCOPE
This Policy applies to the Commemorative Naming or Renaming of municipal streets,
parkland, open spaces, trails, structures and public spaces after a particular individual(s)
or family name.
The Commemorative Naming Policy is intended to recognize the geographical, natural,
Page 2 of 19
cultural, historic features and/or civic significance of properties owned by the Town, as
well as to honour the outstanding achievements, distinctive services, or significant
community contributions made by an individual or group.
Any member of the public or Town Council may submit a nomination application for the
Commemorative Naming or Renaming of a municipal street, parkland, open space, trail,
structure or public building.
This Policy is not intended to address:
Individual naming dedications such as for park benches or tree program memorials;
Naming of Town-owned facilities leased to commercial tenants;
Naming Rights for Municipal Properties (i.e. individual/organization/business purchases
the right to name a facility);
Naming of Town Buildings that provide core services (i.e. Town Hall, Fire Services,
Police Services, EMS). This restriction does not apply to the courtyards, squares,
gardens, lawns, etc. or indoor components of these buildings (wings, halls,
auditoriums, galleries, lounges, lobbies, boardrooms, etc.).
GENERAL
This Policy shall be administered by the Clerk’s Office;
This Policy shall be referred to as the “Commemorative Naming Policy”;
This Policy shall come into force and effect on the date adopted.
AUTHORITY
The authority for the Commemorative Naming Policy shall be by the approval of the
Council of the Town of Tillsonburg.
DEFINITIONS
Commemorative Names Reserve List:
Names submitted that qualify, but may not be chosen by the Committee for a
particular asset, will be added to a list and can be considered for future assets
(Names will be kept on the Commemorative Names Reserve List for 5 years).
Commemorative Naming Committee (CNC):
Shall be comprised of the Special Awards Committee (including the Council
Representative), Town Clerk, Development Commissioner and the Director of
Recreation, Culture & Parks (or Designates). Meetings will be held in-camera, in
accordance with Section 239 (2)(b) of the Municipal Act, “personal matters about an
identifiable individual, including municipal or local board employees”.
Matrix Rating System:
Shall be comprised of weighted questions to assist Committee Members in the
analyzation and determination of qualified/appropriate names for Town assets
(attached as Appendix 'A' of this Policy).
Municipal Street:
Page 3 of 19
Includes a public highway, street, road allowance or lane under the jurisdiction of
the Town of Tillsonburg.
Other Open Spaces:
Valleys, forests/woodlots, watercourses (lakes, rivers), utility features such as storm-
water management areas, downtown squares, and plazas.
Parkland:
Refers to land dedicated by the Town for use as a public park or for recreational purposes.
All parkland designations are defined within the Town of Tillsonburg’s Parks, Recreation,
and Cultural Strategic Master Plan and Zoning Bylaw. For commemoration purposes, the
term municipal park shall include other components, such as sporting fields contained
within a larger park.
PublicBuildings:
Town owned public buildings and their outdoor service areas (pools, arenas, parking
garages, recreation centre, facility yards, plazas, courtyards, squares, gardens,
lawns, etc.), as well as their indoor components (wings, halls, auditoriums, galleries,
lounges, lobbies, boardrooms, etc.).
Public Consultation Process:
The two-way exchange of information between The Town and the public before
decisions are made. It is an open and accountable process allowing individuals and
groups to participate in the decision-making process of naming Town owned assets.
Statistical information on comments received under consultation will be provided to
individuals other than staff, upon request. However, specifics and written comments
received will be available only to the Committee and Town Council.
Trails:
An off-road Recreational path system or Pedestrian walkway which may be made
of Limestone, Asphalt, packed earth, woodchips, granular surface or other
material, for use by walkers, cyclists, snowshoers, cross-country skiers, etc.
Submitting an Application
Applicants are required to submit a completed Commemorative Naming Application Form
(attached as Appendix 'B' of this Policy), the sworn Affidavit Forms (attached as
Appendix 'C' of this Policy) along with the required supporting documentation when
requesting the Commemorative Naming or Renaming of a municipal property.
Background information and/or biographical information (if named after an organization or
an individual) shall demonstrate the significance of the proposed name to the community.
It is recommended that the applicant include letters of support for the request, including
documentation by the individual being honoured or their legal representative. A petition
may also be included in the event that a request is being made for the renaming of a
municipal property.
The commemorative naming process for municipal streets, parkland, open spaces, trails,
structures and public buildings, may differ from application to application depending on
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the circumstances surrounding the request/requirement for naming.
Application Criteria
When an Application Form is submitted, at least one of the following criteria shall apply:
The nominated individual has demonstrated excellence, courage or exceptional
service to the citizens of the Town of Tillsonburg, the Province of Ontario and/or
Canada;
The nominated individual has provided extensive community service and has an
extraordinary community service record;
The nominated individual has worked to foster equality and reduce discrimination; The
nominated individual is a current Town of Tillsonburg employee, and has made an
outstanding contribution to the Town of Tillsonburg unrelated to and outside of his/her job
responsibilities, capacity and duties as a Town employee;
The nominated individual is a former employee of the Town of Tillsonburg and is to be
recognized for his/her exceptional service unrelated to and outside of his/her job
responsibilities, capacity and duties as a former Town employee;
The nominated individual has made a significant financial contribution to parkland, an
open space, trail, structure or public building, and the contribution significantly benefits
the community that the municipal property serves (i.e. the project may not have been
otherwise possible without the financial assistance);
The nominated name has a geographical, natural, cultural, historical or civic significance
to the community, Town of Tillsonburg, Province of Ontario or Canada.
*Out of respect to the deceased, no proposal for the Naming or Renaming of municipal
property shall be considered by the Naming Committee within ninety (90) days of the
death of the person for whom the naming request is being made.
Renaming
The Commemorative Naming Committee will consider renaming an existing Municipal
Asset after receiving a submission from a private individual or organization, or direction
from Council to undertake the Commemorative Naming process as outlined herein.
Recognizing that established names contribute significantly to community identity and
pride, proposals to rename existing municipal property, must be predicated by exceptional
circumstances.
Existing names will not be changed without consideration of:
The historical significance of the existing name;
The impact on the individual or organization associated with the existing name;
The cost and impact of changing existing signage, rebuilding community recognition and
updating records (data bases, letterhead, promotional materials, etc.).
Processing of Application
The following section sets out the procedures for the selection and approval of a
Commemorative name.
Page 5 of 19
Applications received requesting the Commemorative Naming of municipal assets, shall
be forwarded to the Commemorative Naming Committee for consideration. The Naming
Committee will utilize an established Matrix Rating System (refer to Appendix ‘A’ of this
Policy) when evaluating applications. As part of the approval process, a preliminary
investigation of the commemorative name will be conducted to ensure that the name has
not been used in the past and that the nomination is meritorious in nature.
Processing the application involves confirmation of criteria, reference checks (if
applicable), discussion with the applicant and the applicable Town departments, initial
meeting of the Commemorative Naming Committee (CNC), public consultation, compiling
consultation results and a reconvening meeting of the CNC for final decision.
Public notice in regards to the application(s) received, shall be provided in accordance
with the Town of Tillsonburg’s Notice Policy. Notice shall be made in the local newspaper
and on the Town of Tillsonburg website as part of the Public Consultation Process for a
(60) sixty-day period. A copy of the notice shall also be provided to applicable Town
departments.
The notice shall include:
An invitation for public comments in regards to the proposed name(s) of the Town
asset(s), as provided for by the Commemorative Naming Committee;
Directions on how comments can be submitted to the Town for consideration;
Directions on where further information can be found regarding the Commemorative
Naming Program (i.e. Commemorative Naming Policy and accompanying forms,
etc.);
The date on which a report will be scheduled for consideration by Town Council.
Public Consultation
Public consultation is required as the issue of commemorative naming of municipal
property directly affects citizens and provides identity to the communities in which they
live. Through public consultation at the community and Town-wide level, residents will be
able to ensure they maintain a strong connection to their communities and will be able to
gain a better understanding of the individual(s)/family who has been nominated for
commemoration.
Public consultation shall be undertaken in accordance with the size and scope of the
specific municipal property being named. Consultation may consist of formal written
notification of the proposed name to affected community associations, applicable interest
groups and Town of Tillsonburg Advisory Committees (where appropriate).
Advertisements may be placed in the local newspapers, where appropriate, and on the
Town’s website.
Statistical information on comments received under consultation will be provided to
individuals other than the Commemorative Naming Committee, upon request. However,
specifics and written comments received will only be available to the Committee and Town
Page 6 of 19
Council.
Town staff will provide the final decision on a proposal to individuals who submit a
comment under the public consultation component, and provide a copy of the
Commemorative Naming policy and information sheet, when necessary.
Evaluation Process
The CNC shall reconvene to review the public consultation results and departmental
comments. When a name is recommended for approval, an In-camera report to the
appropriate Standing Committee and Council is prepared containing the CNC’s
recommendation.
First consideration by the Naming Committee will be given to those Names that
are representative of the geographical, natural, cultural, or historical features
and/or the civic significance of the municipal property to which the name will be
applied.
Second consideration by the Naming Committee will be given to those Names that
fall under at least one of the following criteria:
The nominated individual has demonstrated excellence, courage or exceptional
service to the citizens of the Town of Tillsonburg, the Province of Ontario and/or
Canada;
The nominated individual has provided extensive community service and has an
extraordinary community service record;
The nominated individual has worked to foster equality and reduce discrimination; The
nominated individual is a current Town of Tillsonburg employee, and has made an
outstanding contribution to the Town of Tillsonburg unrelated to and outside of his/her job
responsibilities, capacity and duties as a Town employee;
The nominated individual is a former employee of the Town of Tillsonburg and is to be
recognized for his/her exceptional service unrelated to and outside of his/her job
responsibilities, capacity and duties as a former Town employee;
The nominated individual has made a significant financial contribution to parkland, an
open space, trail, structure or public building, and the contribution significantly benefits
the community that the municipal property serves (i.e. the project may not have been
otherwise possible without the financial assistance);
The nominated name has a geographical, natural, cultural, historical or civic significance
to the community, Town of Tillsonburg, Province of Ontario or Canada.
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Council Approval
The Commemorative Naming Committee will prepare and send a report to Council
outlining the proposed name for each Town asset and the reasons why the name was
chosen (i.e. analysis against the criteria).
Upon Committee and Council approval, implementation of the approved commemorative
name is undertaken. This involves final notification to the nominee, preparation of an
official letter signed by the Mayor, and an official unveiling ceremony for the nominee and
family with the presentation of a plaque to be erected at the site, indicating the name as
well as its significance for commemoration.
New Development of Municipal Property
Building and Planning Services, will notify the Town Clerk when the new development of
municipal parkland, an open space, trail, structure or public building occurs and provide
information regarding the specific project and the applicable time frame for construction,
Town ownership, and, if applicable, information with respect to proposed names for the
development.
The Town Clerk or designate may convene a meeting of the Commemorative Naming
Committee as required to discuss and name all new municipal properties which have
been identified as requiring a name, or to discuss a recommended commemorative
name.
The Committee shall review the approved list of names eligible for consideration to
determine if there is an appropriate name for the identified project, or undertake
necessary steps to solicit proposed names. If a commemorative name is selected for the
project from the Commemorative Names Reserve List, or a name is recommended
through another means, the public consultation process will commence for (60) sixty
days.
The Commemorative Naming Committee will request comment from the Parks &
Recreation Advisory Committee and/or the Development Committee regarding the
proposed name. The Commemorative Naming Committee will reconvene to review public
comment and develop a final recommendation.
Council Approval
The Commemorative Naming Committee will prepare and send a report to Council
outlining the proposed name for each Town asset and the reasons why the name was
chosen (i.e. analysis against the criteria). After Council approval, staff will initiate the
implementation of the approved Names on official documents, construction and
permanent
signage and plan/implement the appropriate protocols (e.g. dedication ceremony).
Page 8 of 19
Commemorative Street Naming
Commemorative naming of municipal streets shall remain the responsibility of Building
and Planning Services and requests shall be made directly through this department.
Naming proposals shall be vetted through the investigation and criteria evaluation process
of this policy. A meeting of the Commemorative Naming Committee will not be required
for the naming of a street.
Commemorative Names Reserve List Maintenance and Use
A name may be submitted that is not site or venue specific. In this regard, the application
will undergo the same process with respect to the criteria evaluation and investigation
process included within this policy. Staff will discuss possible options with the nominator
and the suitability. If a site or/and geographic location is not determined through these
discussions, the name is placed on the Commemorative Names Reserve List (for
municipal properties) maintained by the Town Clerk, and the Street Names Reserve List
maintained by Building Services.
The Commemorative Naming Committee will meet to review the Name Reserve List, new
submissions and complete the Matrix Rating for each completed submission. They will
also appoint a member to verify the accuracy of the proposed names for each asset,
using reference documents including atlases, other official municipal/civic publications
and local historians/contacts.
In accordance with Council direction, historical names will be given precedence.
Otherwise, there shall be no prioritization system of commemorative names on the list.
Nominators are free to designate the name for use in a specific municipal street
parkland, open space, trail, structure or public building, at the time of nomination if they
chose.
The List shall be made available on request to any interested party, although the results of
the investigations of the naming requests shall remain confidential.
A commemorative name may be used for a municipal street, parkland, open space, trail,
structure or public building only once. If the nominator wishes that a nominated
commemorative name be associated with a particular municipal property, it shall be noted
on the Commemorative Names Reserve List.
The Town Clerk will maintain all applications for commemorative street naming with
respect to criteria and investigation. However, working in cooperation, Building Services
will incorporate commemorative street names on the Building Services Street Names
Reserve List. W here warranted, the Commemorative Names Reserve List shall be
consulted for the purposes of street naming, although a meeting of the Commemorative
Naming Committee shall not be required for street naming.
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SCHEDULE A
THE CORPORATION OF THE TOWN OF TILLSONBURG
MUNICIPAL PROPERTY AND BUILDING COMMEMORATIVE NAMING
SCHEDULE A: Matrix Rating System - For Use By The Commemorative Naming
Committee
ASSET:
PROPOSED NAME:
Check one (1) box for each criteria met. When complete, add and total at the
bottom (5= excellent, 1 = poor).
NO. Criteria RATE WEIGHTING
5 4 3 2 1 (rate x
weighting
number)
1 Civic significance 5
2 Geographical or Natural significance 5
3 Cultural or Historic significance 5
4 Demonstrated excellence,
courage or exceptional service to
the Province or Canada .
3
5 Demonstrated excellence,
courage or exceptional service to
the Tillsonburg community
3
6 Has worked to foster equality and
reduce discrimination 2
7 Has risked or given his/her life to
save or protect others 2
8 Other - creativity and/or
originality of the proposed
naming (e.g. The Bird's Eye
Boardroom)
1
9 Have no other Town owned
asset designations (multiple
existing designations will result
in a lower rate).
1
TOTAL:
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SCHEDULE B
APPLICATION FORM
COMMEMORATIVE NAMING OF A MUNICIPAL STREET, PARKLAND, OPEN SPACE, TRAIL,
STRUCTURE & PUBLIC BUILDING
A. NOMINATOR’SINFORMATION
*A COMMEMORATIVE NAME MAY BE USED ONLY ONCE IN THE TOWN OF TILLSONBURG
SUBSEQUENT REQUESTS WILL BE DENIED
Name (Individual or Organization):
Mailing Address:
Telephone: Home Work E-mail:
Affiliation to Nominee:
B. NOMINEE’S INFORMATION (NAME TO BE COMMEMORATED)
Name:
Mailing Address:
Date of Birth:
Telephone: Home Work E-mail:
Page 11 of 19
E. APPLICABLE CRITERIA (SELECT ONE)
The nominated individual has demonstrated excellence, courage or exceptional service to
the citizens of the Town of Tillsonburg, the Province of Ontario and/or Canada.
The nominated individual has provided extensive community service and has an extraordinary
community service record.
The nominated individual has worked to foster equality and reduce discrimination.
The nominated individual is a current Town of Tillsonburg employee, and has made an
outstanding contribution to the Town of Tillsonburg unrelated to and outside of his/her job
responsibilities, capacity and duties as a Town employee.
The nominated individual is a former employee of the Town of Tillsonburg and is to be
recognized for his/her exceptional service unrelated to and outside of his/her job
responsibilities, capacity and duties as a former Town employee.
The nominated individual has made a significant financial contribution to municipal parkland,
open space, trail, structure or public building and the contribution significantly benefits the
community that the municipal property serves (i.e., the project may not have otherwise been
possible without the financial assistance).
D. NOMINEE’S INFORMATION (NAME TO BE COMMEMORATED)
Name:
C. NOMINATOR’SINFORMATION
*A COMMEMORATIVE NAME MAY BE USED ONLY ONCE IN THE TOWN OF TILLSONBURG
SUBSEQUENT REQUESTS WILL BE DENIED
Name (Individual or Organization):
Page 12 of 19
The nominated name has geographical, natural, cultural, historical or civic significance to the
community, Town of Tillsonburg, Province of Ontario or Canada.
Page 13 of 19
F. RATIONALE FOR NOMINATION AND ATTACHED BACKGROUND INFORMATION RELATED
TO THE CRITERION CHOSEN, WHICH SUBSTANTIATES ALL CLAIMS MADE: INCLUDE COPIES
OF NEWSPAPER ARTICLES, CERTIFICATES, AWARDS, LETTERS OF SUPPORT OR
COMMENDATION, SERVICE RECORDS, PICTURES, ETC.
Please note all information provided below and/or attached to this Application
Form will form part of the Commemorative Naming Application Form and will
therefore be released to the public in any public notices/advertisements produced,
public Agenda and Minutes, Committee discussions/meetings and Reports which
may go forward to Council.
Page 14 of 19
G. PLEASE INDICATE WHAT YOU WOULD LIKE THE NAME USED FOR (PLEASE CHECK ONE):
Street
Parkland
Open Space
Trail
Structure Public Building
H. IS THERE APARTICULAR STREET/PARKLAND/OPEN SPACE/TRAIL/STRUCTURE/OR PUBLIC
BUILDING WHICH YOU WOULD LIKE THE NAME USED FOR?:
1st choice
2nd choice
Property’s Current Identification, Address or Location Information:
I. RENAMING: (Please note that before a Renaming Application is accepted, the nominator must have
written permission from the family or next of kin―if this application results in a request to displace an
existing commemorative name [person, persons, or family]):
Does the property currently have a name? If so, provide current name, details and rationale for
the proposed renaming of this property.
Page 15 of 19
J. ADDITIONAL INFORMATION: (ADD INFORMATION AS NEEDED)
1 The nominee or a representative on their behalf (next of kin, solicitor, notary public, etc.) must provide consent to
this nomination.
K. INVESTIGATION AND REFERENCE CHECKS REQUIRED
A Criminal Reference Check* (CRC) for the nominee is required as part of this process. It
is necessary for the nominee to obtain the CRC. The nominee must provide the Clerk’s
Office with a copy of the processed CRC provided by Police Services together with the
completed Application Form. To obtain a CRC, contact the Ontario Provincial Police Service at
519-688-6540. (Note: If the nominee is deceased, it is not possible to obtain a CRC, but the next
of kin must complete the section below and submit an Affidavit of the next of kin).
In addition to the above, a sworn affidavit* (issued separately) must be provided to the Town
Clerk’s Office. The affidavit provides information with respect to Outstanding Offence Convictions
or infractions under a Federal or Provincial statute.
Please note that an outstanding conviction or infraction under any of the above may result in the
disqualification of an application. Confirmation that the information has been collected through
the above investigations will be presented at the public Commemorative Nominating Committee
meeting at the time of its consideration of the application – but any details of the results of the
clearance checks will only be discussed with Committee Members In-Camera.
CONSENT1
Does the nominee consent to a CRC and providing the information to the Town? Yes No
Does the nominee or nominator consent to a Provincial Offences Act Check? Yes No
Does the nominee or nominator consent to providing the sworn affidavit to the Town? Yes No
Does the nominee or nominator consent to the release of the
status of the clearance checks? Yes No
* Any fees associated with the Criminal Reference Check and/or the sworn affidavit are the
responsibility of the applicant.
Nominator’s Signature Date
Nominee’s Signature Date
2 The nominee or a representative on their behalf (next of kin, solicitor, notary public, etc.) must provide consent to
this nomination.
L. CONSENT TO THE RELEASE OF INFORMATION PROVIDED IN SECTIONS C- J IN WHOLE OR IN
PART
The information collected on this form will be used as part of the Commemorative Naming
Process.
Personal information on the form, attached to the form or subsequently submitted to be included or
attached to the Application Form, and all subsequent information collected as a result of the
research and the staff investigation of the person’s information, and subsequently found on
websites, in local archived materials, in newspapers articles, as a result of a public consultation
process, etc., will be used by Town staff and will be made available to the members of the
Commemorative Naming Committee, the public, the Mayor’s Office and Elected Officials―except
the contact information collected in Sections A and B .
Nominator’s Signature Date
Nominee’s Signature2 Date
SCHEDULE C
MUNICIPAL COMMEMORATIVE NAM ING PROGRAM
TO BE COMPLETED BY THE NOMINEE
AFFIDAVIT OF ___________________________
(Nominee)
I,_________________________, of the Town of Tillsonburg, in the Province of Ontario,
MAKE OATH AND SAY:
1. I have never been convicted of an offence as set out in a Federal Statute.
2. I do not have any outstanding convictions or infractions as set out in the Provincial
Offences Act and/or any Town of Tillsonburg Municipal By-laws.
3. I make this Affidavit in support of the Application Form for the Commemorative
Naming Policy, Town of Tillsonburg, and for no improper purpose.
__________________________
(Nominee)
SWORN BEFORE ME at the
Town of Tillsonburg, in the Province of Ontario, this day of , 20
__________________________
A Commissioner, etc.
MUNICIPAL COMMEMORATIVE NAMING PROGRAM
TO BE COMPLETED BY THE NOMINATOR OR NEXT OF KIN TO THE NOMINEE
(APPLICABLE IF THE NOMINEE IS DECEASED)
AFFIDAVIT OF ___________________________
(Nominator Or Next of Kin)
I, __________________________, of the Town of Tillsonburg, in the Province of Ontario,
MAKE OATH AND SAY THAT TO THE BEST OF MY KNOW LEDGE,
1. Was never convicted of an offence as set out in a Federal Statute.
2. Does not have any outstanding convictions or infractions as set out in the
Provincial Offences Act and/or any Town of Tillsonburg Municipal By-laws.
3. I make this Affidavit in support of the Application Form for the Commemorative
Naming Policy, Town of Tillsonburg, and for no improper purpose.
__________________________
(Nominator or Next Of Kin)
SWORN BEFORE ME at the
Town of Tillsonburg, in the Province of Ontario, this day of , 20
__________________________
A Commissioner, etc.