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Citizen Participation Form

  1. Midlothianlogo 640 x 480

  2. Citizen Participation Form

  3. Citizens are encouraged to watch City Council meetings and other Board/Commission meetings online rather than in person due to concerns related to the spread of COVID-19. Citizens wishing to address the City Council, Planning & Zoning Commission, Zoning Board of Adjustment or any other Board may submit comments on any topic or agenda item electronically by utilizing this Citizen Participation Form. All forms must be received by 5:00 p.m. on the date of the meeting and will be provided for the record.

  4. Meeting Type:*

  5. If you wish to be contacted please provide the following:

  6. Residence:*

  7. Speaker Status:*

  8. Type of Participation:

  9. Representing Applicant?

  10. (If not speaking under Citizens to be heard.)

  11. If applicable:

  12. Statements are limited to 3 minutes.

  13. Leave This Blank:

  14. This field is not part of the form submission.