Membership Application – Regional Review Panel

To apply to participate as a member of the Regional Review Panel, please complete this form.

Name

Position/Title

Organization

Address

City/Town

Postal Code

Phone

Please list all housing providers with which you are associated:

Declaration

I understand that as a member of the Regional Review Panel I may not participate in all reviews conducted by the Panel.
I understand that information disclosed as part of a Regional Review is confidential and agree that I will not share this information outside of the Regional Review.
I acknowledge that I cannot participate as a member of the Regional Review Panel in any reviews resulting from decisions with which I was directly involved or have previously discussed.
I agree to declare a conflict of interest for any decision of which I have prior knowledge.
I agree not to participate in any Regional Reviews related to housing projects or providers with which I am associated.

Signature

Clear

This information is collected under the legal authority of the Housing Services Act, 2011 for the purpose of administering the social housing programs. Questions about this collection can be forwarded to the Director of Housing Services, Region of Durham at 605 Rossland Rd E, Whitby ON, L1N 6A3 or 905-668-7711 or 1-800-372-1102