New Form

Agenda Request Form

Name

Is this request originating from Jefferson County or an outside Organization?

Jefferson County Outside Organization

Jefferson County Department Name

Organization Name

Estimate amount of time needed for appointment

First Choice

Second Choice

If a specific date is needed, please provide reason for specific date:

Subject

Please provide the County Commission with a description of your request or presentation, including any background information

Recommended Motion

Are documents attached?

Yes No

Upload here

Upload

Why not?

Is a projector needed?

Yes No

Email Address

Work or personal email address is acceptable

Phone Number