Share your Community Story Registration form

Share Your Community Story

Whether it's a new friendship, a successful neighbourhood gathering, neighbours supporting one another, or a story that reflects community pride, we'd love to hear how connection is making a difference in your neighbourhood.

Share your story and help showcase how residents are building stronger relationships, creating a sense of belonging, and inspiring pride in Burlington. Your experience may inspire others to get involved and make a positive impact in their neighbourhood.

Personal information being collected in this survey is collected under the authority of the Municipal Act, 2001, S.O. 2001, c. 25 and disclosure of responses will be governed by the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, c. M.56. Your personal information is confidential and survey responses will only be reported in a de-identified, aggregate manner. For questions regarding the collection, use and disclosure of this information, please contact the Manager of Engagement & Marketing at getinvolved@burlington.ca. The survey is available in print, alternative formats or with communication support by contacting getinvolved@burlington.ca

Do you agree to being contacted to share your thoughts and reflections in a short interview?

* required*

Yes

Full Name

* required*

Maximum 255 characters

0/255

* required*

How would you like to be interviewed?

Video call

In-person meeting

What Ward do you live in?

Ward 1

Ward 2

Ward 3

Ward 4

Ward 5

Ward 6

What neighbourhood do you live in? If you are unsure, view the map to see

Maximum 255 characters

0/255

What is your age range

14 - 17 years

18 - 24 years

25 - 34 years

35 - 44 years

45 - 54 years

55 - 64 years

65 - 74 years

75 - 84 years

85+

Prefer not to answer

Do you agree to have the conversation recorded and written down so we don’t miss anything you want to share?

* required*

Yes