PUBLIC HEARING REPLY FORM Persons wishing to present testimony at the public hearing on The Community Services Block Grant (CSBG) Programare requested to complete this reply form as soon as possible and mail it to:
Jill Poklemba |
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I plan to attend the following public hearing on The Community Services Block Grant (CSBG) Program to be conducted by the Assembly Committee on Social Services on June 1, 2005. |
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I plan to make a public statement at the hearing. My statement will be limited to 15 minutes, and I will answer any questions which may arise. I will provide 10 copies of my prepared statement. |
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I will address my remarks to the following subjects: |
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![]() | I do not plan to attend the above hearing. |
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I would like to be added to the Committee mailing list for notices and reports. |
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I would like to be removed from the Committee mailing list. |
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I will require assistance and/or handicapped accessibility information. Please specify the type of assistance required: |
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NAME: |
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FAX TELEPHONE: |
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