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2. Requesting Department*
3. Date Completed
   Date Completed

   Date Completed
5. Name*
6. Email Address
8. Phone Number*
9. Fax Number
11. Meeting Type*
    -- Select One --Work SessionAction Agenda - Regular MeetingPresentation/Special RecognitionSpecial Meeting (48 hour notice required)Schedule Public Hearing (provide sample ad)Schedule Joint Work Session/Meeting*Consent Agenda ItemClosed Session Item *
12. Has been reviewed by County Attorney*

    1. No - does not need attorney review
    2. No - but needs attorney review
    3. Yes - has been reviewed by county attorney
14. Has been reviewed by County Manager*

    1. No - but needs Co. Manager review
    2. No - does not need Co. Manager review
    3. Yes - recommendation attached
    4. Yes - made no recommendation
15. For policy/procedures creation or revisions, has item been reviewed by Human Resources Manager:

    1. Yes
    2. No
17. What action needed from Board?*
18. What action needed from County Manager?
20. Justification & Description (give short summary of topic, why its needed and how item appears on the Agenda).
22. Funding Source provide line item number and type of funding:
23. $ Funds available:
25. See attachment.
26. Agenda items are due to the Clerk no later than 6 working days before meeting (2 weeks if legal review is needed).
28. Additional attachment
30. Additional attachment
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32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit Submit and Print

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