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2. Today's Date*
   Today's Date
3. Proposed Agenda Date*
   Proposed Agenda Date
5. Name of person(s) proposing item*
6. Title
8. Name of Business/Organization (if applicable)
10. Address*
12. City*
13. State*
14. Zip Code*
16. Contact Number*
17. Email Address
21. Item request is for:*
    -- Select One --Information OnlyAction ItemDiscussion/ActionReportOther
23. Description/Summary*

    Submit a brief description/summary of the agenda item (as you would like it to appear on the agenda)

25. Does the subject concern a City Department?*

    1. Yes
    2. No
26. If so, please include the name of the department(s)
28. Does the subject concern a City Ordinance?*

    1. Yes
    2. No
29. If so, please include the Ordinance name or number:
31. Have you addressed your issues(s) with city/administrative staff?*

    1. Yes
    2. No
32. What is your desired outcome?*
36. Disclaimer

    This request must be submitted to the City Clerk no later than the Wednesday prior to the City Council meeting. Council meetings are held on the 1st, 2nd and 4th Mondays at 7:30 p.m. Items submitted after this deadline will be scheduled for the following City Council meeting.

    If presenting any handouts or documents pertaining to the topic, please plan to provide at least 12 copies. 

    If using other forms of media (PowerPoint Presentation, and/or Flash Drive), the final version must be submitted to the Clerk's office, before the Council meeting. 

    Electronic documents can be emailed to [email protected] or you may utilize the upload tool below. 

    According to City Council policy, it is mandatory that the petitioner be present to be heard by Council.

    Matters pertaining to personnel, litigation, and violations of laws and ordinances are excluded from the agenda. Rules of decorum as provided on the back of the Council meeting agenda will be observed.

38. Upload Supporting Documents

    File types allowed: PDF, JPG, DOC, DOCX, and RTF

42. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    
    

    1. I agree.
44. Electronic Signature*
45. Date Signed*
    Date Signed
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47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit Submit and Print

* indicates a required field