Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Request a Proclamation

  1. Disclaimer
    Information submitted on this form will be sent via unsecured email. To protect sensitive information, do not enter the following items or similar information on this form: Social Security numbers, driver’s license numbers, bank account information, routing numbers, credit card numbers, medical information, passport numbers, and passwords. Please review our privacy policy located at www.jeffco.us/privacy. By submitting this form, you acknowledge and accept the terms listed in the privacy policy.
  2. Please Answer the Following: *
    Which date span do you wish to proclaim? A date option will appear based on your selection.
  3. Please select the single date you request to proclaim.
  4. Please select the week-long period you wish to proclaim.
  5. Please select the month-long period you wish to proclaim.
  6. Please select the day you wish the proclamation to be issued and/or dated.
  7. Delivery Method*
    Please select the desired delivery of your requested proclamation.
  8. If attaching a file with the sample proclamation language, please type "N/A"
  9. Upload a draft copy of your proclamation
  10. Requested By:
  11. Leave This Blank:

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