1

 Please enter your contact information

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Name

2

 Address

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Address

3

City

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City

4

Zip Code

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Zip Code

5

Phone Number

Phone Numberext.

6

Email Address

Email Address

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Please review the following City services and rank then in importance from 1-7, with 1 being the most important.

7

 Keeping public areas safe

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Keeping public areas safe

8

Repairing streets and potholes

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Repairing streets and potholes

9

Maintaining firefighters and paramedics

 *

Maintaining firefighters and paramedics

10

Maintaining 911 emergency response times

 *

Maintaining 911 emergency response times

11

Protecting local drinking water supplies

 *

Protecting local drinking water supplies

12

Maintaining vital city services

 *

Maintaining vital city services

13

Maintaining gang and drug prevention programs

 *

Maintaining gang and drug prevention programs

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14

Please provide some feedback on city priorities.

Please provide some feedback on city priorities.

15

Please provide any suggestions for additional service priorities.

Please provide any suggestions for additional service priorities.

16

Do you have any questions?

Do you have any questions?

17

Would you like to be kept informed on issues in regards to city priorities?

Would you like to be kept informed on issues in regards to city priorities?

Yes

No

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