| (a) |
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Signature |
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Name (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 Community
College District No. 3 |
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Time of Day
Request Made |
| (c) |
Nature of request . . . . . . . . . . . . |
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| (d) |
Description of Record, or Matter, Requested if not
Identifiable by Reference . . . . . . . . . . . . |
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| Request: Approved . . . . . . . . |
By . . . . . . . . . . . . |
| |
Date |
Public Records Officer |
| Denied Date . . . . . . . . . . . . |
| Reasons for Denial: . . . . . . . . . . . . |
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| Referred to . . . . . . . . . . . . . |
Date . . . . . . . . . . . . |
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By . . . . . . . . . . . . |
| |
Public Records Officer |