The purpose of this form is to receive and respond to feedback on how our goods or services are provided to people with disabilities. Please send the completed form to the attention of the Principal of Equity, Diversity and Inclusive Education, Catholic Education Centre, 40 Matheson Blvd West, Mississauga, ON, L5R 1C5, Fax Number 905-890-8837.

Name:

Contact Information:

(state telephone number and the best time to contact you and/or your email address)

Please state your concern:

Please state the location and date pertaining to your concern:

Did you speak with anyone at the facility regarding your concern? Yes No

If yes, please provide the contact name if known (Principal/Manager, Other)

What was their response?

How can we assist you?

Additional Information:

'Personal information on this form is collected under the legal authority of the Accessibility for Ontarians with Disabilities Act and will be used to monitor issues and to receive feedback under the Accessibility Standards for Customer Service.  Questions regarding this collection are to be directed to the Principal of Equity, Diversity and Inclusive Education. “