WAC 72-276-140 Adoption of form. The school hereby adopts for use by all persons requesting inspection and/or copying or copies of its records the following form:

REQUEST FOR PUBLIC RECORD TO

WASHINGTON STATE SCHOOL FOR THE BLIND

(a) . . . . . . . . . . . .
	Name (please print)	Signature
	. . . . . . . . . . . . Name or Organization, if applicable
	. . . . . . . . . . . .
	Mailing Address of Applicant		Phone Number
	. . . . . . . . . . . .
(b)	Date Request Made	Time of Day Request Made:
(c)	Nature of Request . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(d)	Identification Reference on Current Index аааа (Please Describe) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(e)	Description of Record, or Matter, Requested if not Identifiable by Reference to the Washington State School for the Blind . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Request: APPROVED . . . . .		DENIED . . . .		Date. . .
By . . . . . . . . . . . .
Name		Title
Reasons for Denial: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Referred to. . . . . . . . . . . . .		Date . . . . . . . . . . . .
By . . . . . . . . . . . .
Name		Title

[Statutory Authority: RCW 72.40.022 and 42.17.250. 90-16-009, з 72-276-140, filed 7/19/90, effective 8/19/90.]