WAC 132D-276-140   Adoption of form.  The district 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

COMMUNITY COLLEGE DISTRICT NO. 4

(a)	. . . . . . . . . . . . Name (please print)		. . . . . . . . . . . . Signature
	. . . . . . . . . . . . Name of Organization, if Applicable
	. . . . . . . . . . . . Mailing Address of Applicant		. . . . . . . . . . . . Phone Number
(b)	. . . . . . . . . . . . Date Request Made		. . . . . . . . . . . . Time of Day Request Made
(c)	Nature of Request . . . . . . . . . . . .
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(d)	Identification Reference on Current Index (Please describe)
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(e)	Description of Record, or Matter, Requested if not Identifiable by Reference to the Community College District No. 4
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Request:		APPROVED . . . . . . . . . . . .	DENIED . . . . . . . . . . . .	Date . . . . . . . . . . . .
By	. . . . . . . . . . . . Name		. . . . . . . . . . . . Title
Reasons for Denial: . . . . . . . . . . . .
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Referred to . . . . . . . . . . . .			Date . . . . . . . . . . . .
By	. . . . . . . . . . . . Name		. . . . . . . . . . . . Title

[Statutory Authority: RCW 28B.50.140. 89-11-024 (Order 89-07), § 132D-276-140, filed 5/11/89.]