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2. AGENDA ITEM REQUEST FORM
4. DATE OF MEETING REQUESTED:
5. REQUESTED BY:
7. DATE OF REQUEST:
8. DEPARTMENT:
9. WARD:
11. ADDRESS:
13. EMAIL:
14. TELEPHONE NO:
16. OPTIONS OF REQUEST

    1. PUBLIC COMMENTS (3 MINUTES)
    2. ACTION ITEM
    3. DISCUSSION/ACTION (3 MINUTES)
    4. REPORT
    5. PUBLIC HEARING
    6. EXECUTIVE SESSION
17. POWER-POINT

    1. YES
    2. NO
    3. Other
19. (NOTE: MAX OF THREE (3) MINUTE PRESENTATION)
21. AGENDA ITEM SUBJECT:
23. BACKGROUND:
25. ACTION REQUIRED:
27. Requester Signature:
29. ADMINISTRATIVE APPROVAL:
30. DATE:
32. FISCAL APPROVAL:
33. DATE:
35. HUMAN RESOURCES:
36. DATE:
38. *** REQUEST MUST BE COMPLETED AND APPROVED BY THE ABOVE LISTED INDIVIDUALS***
40. Request(s) to be added to the agenda MUST be received by the City Clerk’s Office four (4) working days prior to the meeting date by noon. All backup documentation MUST be attached in order for this item to be placed on the agenda.
44. FOR OFFICIAL USE ONLY
46. Notification date:
47. Notified By:
49. Meeting date:
50. Mode of Notification:

    1. Telephone
    2. Email
52. Date of Meeting:
53. Meeting Type:

    1. Regular
    2. Special
54. Action Taken:

    1. Approved
    2. Disapproved
    3. Tabled
    4. Other
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field