• Language assistance services may be available to you when attending a public meeting.
• The request form must be submitted via email by 2:00 PM the day before the public meeting.
• The City will attempt to provide the requested services.
• Please note: the City uses a free web-based translation service for written text. The City does not
  guarantee the exact translation of written materials.

1

Contact Information

 *

Contact Information

Today's Date:	Name:
Phone Number:	Email Address:

2

Would you like to make a public comment?

 *

Would you like to make a public comment?

Yes

No

3

Will you be coming to the public meeting in person?

 *

Will you be coming to the public meeting in person?

Yes

No

4

Meeting Name:

 *

Meeting Name:

Administration & Finance Committee

Arts, Culture, and Library Advisory Committee

Community Services Advisory Committee

City Council Meeting

Hotel/Motel Tax Advisory Committee

LEOFF 1 Disability Board

Parks & Recreation Committee

Planning and Economic Development Committee

Planning Commission

Public Safety & Justice Committee

Senior Citizen Advisory Committee

Transportation & Public Works

Tree Board

Other If other, type text here.

5

Meeting Date:

 *

Meeting Date:

6

Language Help Requested

Language Help Requested

Interpreter Needed

Translation of Agenda

Translation of Certain Meeting Packet Documents

7

Requested Language for Service

Requested Language for Service

Amharic

Spanish

Somali

Vietnamese

Other If other, type text here.

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