Proclamation Request Form

Requester Name: *

Requester Organization/Agency: *

Is your organization/agency a state government agency? *

Yes

Mailing Address (where the completed document should be mailed):

Recipient *

Organization (if applicable)

Street Address 1 *

Street Address 2

City *

State *

Zip Code *

If the option is available, would you like to pick up the proclamation from the Administration Building (116 W. Jones St., Raleigh, NC) instead of having it mailed? *

Yes

Requester Phone: *

Please format as XXX-XXX-XXXX.

Requester Email: *

Would you like to receive a PDF of the proclamation? *

Yes

Requested Title of Proclamation: *

(Example: North Carolina Tar Heel Week)

Requested Proclamation Date (MM/DD/YYYY): *

(or date range if requesting week, month, or year)

Suggested Text of Proclamation: *

Please include all text for the proclamation below. Your draft should be 4-6 whereas clauses that show the importance and relevance of the proclamation to the people of North Carolina. Requests submitted without text will not be processed until a draft is provided. Find examples of proclamations.

Sources *

If you have not already, please use the space below to cite the sources for any statistics and/or information used in your suggested text. This will help us to verify this information.

Is the proclamation to be presented at an event? *

Yes

If you would like to invite the Governor or the Office of the Governor to attend or be involved in an event, please submit a Scheduling Request separate from this proclamation request.

Additional Information (optional):

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