Community Members Council Meeting Request Form
• Council welcomes community members appearing before Council to address specific subject matters.

• These meetings are for Community members and residents who have a Residency Permit, and any off-reserve members who are Band Members.
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REQUIREMENTS CHECKLIST - please check all boxes before proceeding.
Section A (Mandatory)
Date Of Request:
MM
/
DD
/
YYYY
Email:
Name:
Band Number (If applicable):
Residency Permit (If applicable):
Address:
Phone:
Cell Phone:
Alternate Phone:
Section B
Does your topic involve: (please check off as many that apply)
Is your issue time sensitive?
Clear selection
If yes, please explain:
If your topic is regarding a Serpent River First Nation department or policy, indicate which department(s) below – please choose only one option below that best applies to your topic:
Clear selection
Section C (mandatory)
What is the proposed agenda topic?
Section D (mandatory)
What outcome are you seeking from a meeting with Council?
Please explain your topic in as much details as possible:
Have you attempted to resolve the issue with the Department or individual?
Clear selection
You must be able to fully demonstrate you have made every attempt to obtain a resolution to the issue with the respective department. Please provide a summary below:
Miigwetch for your request,
Please email any administration forms, letters, e-mails, or other documents to support your matter to political.asst@serpentriverfn.com. If you have any questions regarding filling out your form, please contact a staff person, a member of Chief and Council or the Executive Assistant to the Political Office. You will receive a receipt/acknowledgment that it was received.
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