Lobbying Act form for UM Staff
Fields with an asterisk are required.
1. Employee Information
Name: *
Title: *
Email: *
Department/Unit:
Date form submitted:
2. Disclosure of Activity
Have you had any pre-arranged oral communications (meetings or phone calls) with a public office holder (POH) and/or designated public office holder (DPOH) within the past month?
YesNo*

POH and DPOH are defined as:

  1. A minister of the Crown or a minister of state and any person employed in his or her office;
  2. Any other public office holder who occupies the senior executive position, whether by the title of deputy minister or an assistant deputy minister or occupies a position of comparable rank;
  3. Any individual who occupies a position that has been designated by regulation under the provisions of the Lobbying Act;
  4. A member of the Senate or the House of Commons and any person on the staff of such a member
  5. A person who is appointed to any office or body with the approval of the Governor in Council, other than a judge receiving a salary under the Judges Act or the lieutenant governor of a province;
  6. An officer, director or employee of any federal board, commission or other tribunal;
  7. A member of the Canadian Armed Forces;
  8. A member of the Royal Canadian Mounted Police.

If yes, pursuant to the Federal Lobbying Act, certain information needs to be disclosed relating to these communications. Please provide details below: (If you require additional fields please complete supplementary forms)

3. Details of Communications with POH/DPOH
Date of Communication
Name of POH/DPOH:
Position title:
Branch or Unit:
Government Institution:
Subject matter of communication:
4. Previously Held Public Office(s)
Have you had any pre-arranged oral communications (meetings or phone calls) with a public office holder (POH) and/or designated public office holder (DPOH) within the past month?
YesNo*
If yes, please provide the following information:
Name of Public Office held:
Position held:
Dates in position:
 
Name of Public Office held:
Position held:
Dates in position: