Form Center

Organization Information

Thank you for your interest in working with the City of Coquitlam’s Community Recreation Department to bring new programs to the community.
Please complete this form with details about your proposed program.
Submitting this form is the first step in the process. It does not guarantee that your proposal will be approved or selected. Please note that approved programs can take approximately 6 months to be fully implemented.
Business/Organization Name*
Primary Contact Name*
Email Address*
Phone Number*
Website (if applicable)
Mailing Address*
City*
Province*
Postal Code*
Type of Organization*
1. For-profit
2. Non-profit
3. Community Group
4. Individual Contractor
5. Other
If Other, please specify
Brief Description of the Organization's Mission and Values*
If you have spoken with a City staff member, please list their name and contact details below.
Continue

Have you delivered this or a similar program before?*
1. Yes
2. No
If yes, please provide an example including where and when? Please provide contact information.
Describe your advanced experience, education and/or certifications in the area of instructions.*
How is participant safety supported during the program?*
Please explain how your program will be accessible and inclusive.*
Example: adaptable for abilities, language accessible, culturally inclusive, etc.
Continue |Go Back

How does this program align with the City’s priorities?*
Example: wellness, lifelong learning, diversity and inclusion, volunteerism, seniors, youth development.
How does the program provide value to the community?*
Example: builds skills, reduces isolation, promotes wellness, cultural enrichment
How will the program be evaluated?*
Example: surveys, attendance tracking, participant feedback, outcome measurement
Continue |Go Back

Please provide two references from organizations or municipalities where you have delivered programming (if applicable).*
Please upload additional supporting documents.
Program outlines, certifications etc.
Freedom of Information and Protection of Privacy Act
I understand by submitting this form I am consenting to the collection, storage, use and disclosure of my personal information for the purposes of the City’s recreation programs and services in accordance with the Freedom of Information and Protection of Privacy Act. I understand that my personal information will be disclosed to a third-party service provider (i.e. Civic plus) with servers located in Canada for the purpose of processing my request. If you have questions or concerns about the collection of your personal information, please contact Karen Basi, Manager Community Recreation by email or call 604-927-6962.

Leave This Blank: