Public Participation

	Meeting Date:*
	mm/dd/yyyy

	Is your request for public participation related to an agenda item?*
	Is your request for public participation related to an agenda item?* YesNo

	Please provide a brief outline of your remarks:*

	Name:*

	Address:*
	Street:   City, State and Zipcode:

	Daytime Phone Number:*

	Email Address:*

	Subdivision (if applicable):

	My children attend (list schools if applicable):

	If documents are a part of your presentation, please cut and paste the documents/text here.