PUBLIC HEARING REPLY FORM
Persons wishing to present testimony at the public hearing on community based programs for youth are requested to complete this reply form as soon as possible and mail it to:
Katie Birchenough
Assembly Committee on Children and Families
Room 522 - Capitol
Albany, New York 12248
Email: birchek@assembly.state.ny.us
Phone: (518) 455-4371
Fax: (518) 455-4693
I plan to attend the public hearing on community based services for at-risk youth to be conducted by the Assembly Committee on
Children and Families
I plan to make a public statement at the hearing on community based services for at-risk youth. My statement will be limited to 10
minutes, and I will answer any questions which may arise. I will provide 10 copies of my prepared statement.
I will address my remarks to the following subjects:
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I do not plan to attend the above hearing.
I would like to be added to the Committee's mailing list for notices and reports.
I would like to be removed from the Committee's mailing list.
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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TITLE:
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ORGANIZATION:
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ADDRESS:
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E-MAIL:
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TELEPHONE:
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FAX TELEPHONE:
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