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2. Name of person / organization requesting proclamation*
3. Is requested proclamation for a person/organization housed in Plainville?*

   1. Yes
   2. No
5. Contact Phone Number*
6. Contact Email*
8. Proclamation requests in the Town of Plainville must fulfill at least one of the following criteria to be eligible for consideration. Which criteria does this request fulfill?*

   1. Town-Wide Significance
   2. Promote Diversity, Equity, and Inclusion
   3. Recognize the contributions of a public official in Plainville or a group of public officials
   4. Local Art and Cultural Celebrations
   5. Charitable Events
10. Name of Event / Organization / individual to be written on proclamation*
12. Brief summary / background of the event, service, or organization*
14. Points to be added as "Whereas" Statements within Proclamation (Minimum four)
16. Please indicate the type of time recognition desired. Example(s): Leonard Nimoy DAY, Nurses WEEK, Black History MONTH*

    1. Day
    2. Week
    3. Month
18. Proclamation Start Date
    Proclamation Start Date
20. Proclamations are presented to individuals and organizations at Select Board meetings. Please indicate how you intend on accepting the proclamation*

    1. Proclamation to be presented at Select Board meeting
    2. Proclamation to be picked up at the Town Administrator's Office
22. In the case this request is not granted a proclamation, would you like the request considered for the town's other ceremonial documents? (Not required)

    1. Certificate of Recognition
    2. Congratulatory Letter
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24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field