. . . . . . . . . . . .
Signature |
|
. . . . . . . . . . . .
Name (please print) |
. . . . . . . . . . . .
Name of Organization |
. . . . . . . . . . . .
Mailing Address of Applicant |
|
. . . . . . . . . . . .
Phone Number |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Date Request Made at Community
College District No. 23 |
. . . . . . . . . . . .
Time of Day
of Request |
| Nature of Request . . . . . . . . . . . . |
| . . . . . . . . . . . . |
| . . . . . . . . . . . . |
| Identification Reference on Current Index (please describe) |
| . . . . . . . . . . . . |
| . . . . . . . . . . . . |
| . . . . . . . . . . . . |
| Description of record or matter requested, if not identifiable
by reference to current index of Community College District
No. 23. |
| . . . . . . . . . . . . |
| . . . . . . . . . . . . |
| . . . . . . . . . . . . |
| Request Approved . . . . . . . . . . . . |
By . . . . . . . . . . . . |
|
|
Date |
Public Records Officer |
| Request Denied . . . . . . . . |
Reasons for Denial . . . . . . . . . . . . |
| . . . . . . . . . . . . |
| . . . . . . . . . . . . |
| . . . . . . . . . . . . |
| Referred to . . . . . . . . . . . . . |
Date . . . . . . . . . . . . |