APPENDIX "A"
REQUEST FOR PUBLIC RECORD TO
STATE BOARD FOR COMMUNITY AND TECHNICAL COLLEGES
| (a) |
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Signature |
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Signature (Please Print) |
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Name of Organization, if
Applicable |
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Mailing Address of Applicant |
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Phone Number |
| (b) |
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Date Request Made at State Board
for Community and Technical
Colleges |
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Time of Day
Request Made |
| (c) |
Nature of request . . . . . . . . . . . . |
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| (d) |
Identification Reference on Current Index . . . . . . . . . . . . |
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Please Describe |
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| (e) |
Description of Record, or Matter, Requested if not Identifiable
by Reference to the State Board for Community and Technical
Colleges Index . . . . . . . . . . . . |
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| Request: Approved |
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Date |
By . . . . . . . . . . . .
Public Records Officer |
| Denied Date . . . . . . . . . . . . |
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| Reasons for Denial: . . . . . . . . . . . . |
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| Referred to . . . . . . . . . . . . |
Date . . . . . . . . . . . . |
| |
By . . . . . . . . . . . .
Public Records Officer |