Board of Education - Public Comment Request Form

Your Name (as it appears on a Government-issued form of identification) Your Name (as it appears on a Government-issued form of identification) First Last
Your Preferred Telephone Number Your Preferred Telephone Number - ### - ### ####
Your Preferred Email Address
Your Zip Code
Are you a: (select one)

Are you a: (select one) Resident of Frederick County Landowner in Frederick County Business Owner in Frederick County FCPS Student FCPS Staff FCPS Parent Elected local, state, or federal representative for Frederick County
If you selected Resident, Landowner, or Business Owner in Frederick County and your government-issued identification does not a Frederick County address, please upload the appropriate documentation below. See Policy 102, Meetings, for accepted supporting documents. The failure to provide the necessary proof may disqualify you from public comment at the meeting for which you are registering.
On what date is the Board meeting at which you intend to speak?
Provide a brief statement of the subject upon which you plan to speak. For example, you might enter "The budget" or "Policy 102"
Provide a brief statement of the subject upon which you plan to speak. For example, you might enter "The budget" or "Policy 102"
Do you require an interpreter or some other accommodation to support your public comment?

Do you require an interpreter or some other accommodation to support your public comment? Yes (explain below) No
If you require an interpreter or other accommodation, please describe the need below.
Do you have a document to attach to the public comment request form. Please note: Only written comments in PDF or Word form will be included in the meeting record. Proof of residency, landownership, or business ownership will be used to determine eligibility to give public comment but will not be included in the meeting record.
I certify that the information submitted is true and accurate to the best of my knowledge.
I understand that falsification of any information on this form may result in my disqualification from pre-registered public comment at the meeting for which I am registering to provide public comment.
I understand that submitting this form does not guarantee me an opportunity to speak during the pre-registered public comment period at the meeting for which I am registering to provide public comment.