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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.