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Step One

Introduction
Use this form to request placement on the agenda for an upcoming Board of Commissioners meeting. Providing accurate and detailed information ensures your request is routed appropriately and addressed efficiently.
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Applicant & Topic Information

Name*
Phone Number*
Address
Email Address*
Department/County Operation*
Choose the department or operation most applicable to your concern. This information is for internal use only and helps ensure your request is routed to the appropriate department or official for review.
Brief Description of Issue/Concern*
Provide a brief description of the issue or concern you would like to address. Be as specific as possible, including any relevant details such as locations, timelines, or individuals involved. This information helps the county better understand your request and address it efficiently.
Have you previously spoken to the commission about this matter?*
1. Yes
1. No
If "yes," when?
If "yes," when?
Approximate date will suffice.
Have you previously spoken to a county employee about this issue?*
1. Yes
1. No
Note: "County official" does not include commissioners and instead refers to county employees such as department heads, administrative staff, or other personnel directly involved in county operations.
If "yes," please provide details about who you spoke to and when.
Provide the name of the county official you spoke to and the approximate date of your conversation. This helps us understand the history of your concern and any previous actions taken.
Preferred Outcome or Request
Select the outcome or request that best describes what you hope to achieve by addressing the commissioners. This information helps guide next steps and ensures your concern is handled appropriately.
Specify Your Request
If you selected "Other" in the dropdown, please use this field to describe your specific request or desired outcome in detail. This helps ensure your concern is directed to the appropriate department or addressed effectively by the commissioners.
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Acknowledgements and Signature

I understand and acknowledge the following as part of the process to address the Emanuel County Board of Commissioners:
1. Submitting this form does not guarantee placement on the agenda. My name, contact information, and topic will be shared with the county administrator and commissioners for review.
2. I may be contacted prior to the meeting by the county administrator or a commissioner to discuss my concerns, as many issues can be resolved without formal agenda placement.
3. If I still wish to speak after this discussion, I must notify the county clerk to confirm my placement on the agenda. The clerk will inform me of the meeting date (almost always the third Monday of every month at 6 PM inside the courthouse), but it is my responsibility to attend as reminders will not be issued.
4. Requests to speak must be submitted at least one week in advance of the meeting. Late requests may result in being deferred to the next meeting.
5. If I am unable to attend after being placed on the agenda, I will notify the county clerk to cancel my request.
6. If I miss the meeting and still wish to address the commissioners, I understand I will need to submit a new request.
Please indicate your acknowledgement by providing your electronic signature.
Electronic Signature Statement
By checking the "I agree" box, you agree and acknowledge that your electronic signature is valid and binding upon you to the same force and effect as a handwritten signature.
I Agree*
1. Electronic Signature
Signor's Name*
Date*
Date

Leave This Blank:

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

This field is not part of the form submission.
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Applicant & Topic Information

Acknowledgements and Signature

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