Public Participation Form
Description of Concern
What is the date of the Meeting youd like to be recognized on?
Have you contacted the responsible department prior to this request to address the City Council? Yes / No
If you answered yes, please list the name of the person you spoke with, and the date you spoke with them
Citizen Signature Date
City Clerks Official/Employee Stamp Date Received
Office Use Only
Was the request filed before 12:00 p.m. the Wednesday preceding the meeting?
Are there any maps, sketches, or drawings filed with the participation request?