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Public Participation Form

 

Citizen Name:                                                                                                                                     

Citizen Address:                                                                                                                    

                                       _________________________________________________________________

Contact Number(s):                                                                                                                                                   

 

Description of Concern

 

 

 

 

 

 

 

 

 

What is the date of the Meeting you’d 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 Clerk’s 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?