Commemorative Naming Application

Nominator's Information

Information Concerning the Proposed Name

Note: A Commemorative Name may be used only once in the City of Port Coquitlam – subsequent requests will be denied.
Applicable Criteria (Check all that apply):

Nominee Information

If the name suggested relates to the commemoration of an individual who is alive, please provide the individual’s contact information in the section below.

Additional Information

Please attach the following information, as required in the Commemorative Naming Policy.

Background information and/or biographical information (if named after an organization or an individual) demonstrating that the proposed name is of significance to  the community and/or the municipality.
One file only.
2 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, sit, svg.
Documentation including reference letters from organizations and individuals providing substantial support for the request.
One file only.
2 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, sit, svg.
A signed Letter of Consent verifying that the person/family/organization being honoured is in agreement with  the naming proposal (if they are living), or by their legal representative should they be deceased.
One file only.
2 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, sit, svg.

Criminal Reference Check

A Criminal Reference Check (CRC) for the nominee is required as part of the application process. It is necessary for the nominee to obtain the CRC.

Please consent to the following:
Sign above
The information collected on this form will be used as part of the Commemorative Naming process. Personal information on the form and information collected as a result of the application processing and staff investigation will be used by City staff and may be made available to the internal stakeholders.

Personal information entered on this form is collected under the authority of Section 26(c) of the Freedom of Information and Protection of Privacy Act (FOIPPA) for the purposes of processing your input. If you have any questions or concerns about the collection of this information, please contact the City’s Records and FOIPPA Administrator at 604.927.5250 or [email protected].