Request Tracker Forms • Proclamation Request Form

Proclamation Request Form

Leave This Blank:

Is this request from a City agency?*

Yes

In the space provided below please provide a summary/background of the individual, group, or organization making the request?*

Start Date (for proclamation begin dates): (format: MM/DD/YYYY)*

End Date (for proclamation end dates): (format: MM/DD/YYYY)*

What is the significance of the chosen date range? *

Is the requested document intended to recognize an organization or an individual? Enter the name or organization:

Title of the Proclamation?*

Please provide proposed verbiage in the space below, including 5-6 WHEREAS clauses.
(Ff you prefer for City staff to develop the proclamation, leave this blank)

Please use the following space to cite the sources for any statistics and/or other information used in your proposed verbiage.

Date you need this proclamation? (format: MM/DD/YYYY)*

Name:

Email: (format: hello@email.com)*

Phone: (format: XXX-XXX-XXXX)*

Address to mail the signed proclamation (or type pick-up):

Is this request affiliated with an organization? If so, please describe it here.

* indicates required fields.

Live Edit

MIDDLETON | WI