Public Meeting Comment Form FM 359 from FM 1093 to Mason Road Survey

1.Comments

2.Name and Address - Optional (if you would like to receive future notifications about this project)

Title (e.g. Mr., Ms.)

First Name

Last Name

Mailing Address

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

3.Organization (if applicable)

Organization Name

Position

4.I am an Elected Official

Yes

No

5.Per Texas Transportation Code, §201.811(a)(5): check each of the following boxes that apply to you:

I am employed by TxDOT.

I do business with TxDOT.

I could benefit monetarily from the project or other item about which I am commenting.

6.I support the proposed project

Yes

No

8.Title VI Information (Optional)
This information is used to help improve TxDOT’s outreach efforts.

9.Title VI Information (Optional)
Are you of Hispanic / Latino / Spanish origin?

Yes

No