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Request a Screening

Use this form to request a Screening Review by a Screening Officer. Reviews can be conducted by email, video, phone, or in person. Once submitted an administrator will contact you to schedule your Screening Review unless you have requested an email review. Please note that a $25.00 fee will be applied if you fail to attend your scheduled Screening Review (does not apply for email reviews).

Penalty Notice Number:

Screening Preference Method:

In person

In writing

Telephone

Video

Full name:

Full address, including postal code:

Phone Number:

Email address:

Please use the below statements box and/or upload section to provide any additional statements, information or documents you would like the Screening Officer to review.

Statements or Information:

Please provide any documents you would like the Screening Officer to review:

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Declaration:

You attest that all information you provide is accurate, complete, and truthful to the best of your knowledge. You acknowledge that any false, misleading, or incomplete information may result in the rejection of your submission.

To the extent that the following information constitutes personal information as defined in the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, chapter M.56 as amended, the information is subject to provisions of that Act and will be used for the purposes indicated or implied by this form. Questions about the collection of personal information should be directed to the County of Brant, 519.44BRANT (519.442.7268) or toll free 1.855.44BRANT or info@brant.ca.