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

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Citizen Signature                                                                                             Date

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City Clerk’s Official/Employee                                                                     Stamp Date Received