Under the Environmental Protection and Enhancement Act (Section 91), under the Water Act (Section 115), under the Climate Change Emissions Management Act (Section 42) and under the Government Organization Act (Schedule 5, Section 6).


First Name:    Surname: 
Town/City:          Postal Code: 
Phone:                           Fax: 

consider myself affected by a decision made according to the Environmental Protection and Enhancement Act, the Water Act, the Climate Change Emissions Management Act or the Government Organization Act, and hereby appeal to the Environmental Appeals Board.

The information collected on this form is necessary to allow the Environmental Appeals Board to perform its function. The information is collected under the authority of the Freedom of Information and Protection of Privacy Act, section 33(c). Section 33(c) provides that personal information may only be collected if that information relates directly to and is necessary for the processing of your appeal. The information you provide will be considered a public record. If you have concerns with your information being part of the public record or if you have questions about how the Board deals with your information, please contact Gilbert Van Nes, General Counsel, Environmental Appeals Board.

If you are being represented, please supply the following information regarding the person representing you:

First Name:    Surname: 
Town/City:          Postal Code: 
Phone:                           Fax: 

You must provide all the information requested. If you have any questions, please contact the Board. The Board is separate and apart from Alberta Environment and therefore the Board has no information related to any matters until a Notice of Appeal is filed and the Board requests the information from Alberta Environment. We do not have your Statement of Concern that you filed with Alberta Environment and if you want the Board to consider the matters raised in your Statement of Concern, you should repeat those concerns in this Notice of Appeal.


I am appealing the decision of (name and title of person from Alberta Environment who made the decision) issued to (name of company or person):

Date issued:

Location of operation or activity which is the subject of Alberta Environment's decision (municipality, county, etc.):

On what date and how did you receive notice of Alberta Environment's decision:

Please provide any further information you may have regarding the decision you are appealing. The information can be found on the decision or the notice of decision from Alberta Environment and will assist us in processing your appeal:

Water Act (file, application, licence, approval, enforcement action, or other numbers)

Environmental Protection and Enhancement Act (file, application, approval, licence, enforcement action, reclamation certificate, or other numbers)

Climate Change Emissions Management Act (file, compliance order, administrative penalty, or other numbers)

Government Organization Act (file, application, or other numbers)

2. Please select one of the following. The Notice of Appeal is submitted under the:
 Environmental Protection and Enhancement Act
 Water Act
 Climate Change Emissions Management Act
 Government Organization Act

Please ensure that you state all your concerns, objections, and reasons in this Notice of Appeal as you may be prevented from raising them later in your appeal if you do not include them here. Please be specific and forward any additional information or documents if necessary to the Board to Gilbert Van Nes at gilbert.vannes@gov.ab.ca.


What parts of Alberta Environment's decision do you not like? Please refer to the section of the approval, licence, reclamation certificate, order, etc., issued by Alberta Environment.


(a) What are your concerns with Alberta Environment's decision?

(b) How is Alberta Environment's decision affecting you?

(c) Why do you not like the decision made by Alberta Environment?


What would you like the Board to do to resolve the specific concerns you have noted above?

Please feel free to attach copies of any additional documents that may be of assistance to the Board.

Submitted by: 

Dated at:    On:

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You are also required to provide the Board with an original, signed copy of your appeal that you are filing on line. Please print this form when you have completed and forward to:

Environmental Appeals Board
306 Peace Hills Trust Tower
10011 - 109 Street
Edmonton, Alberta
T5J 3S8

Or fax to: (780) 427-4693



You may also CLICK HERE to download the Notice of Appeal form in PDF format