WAC 132Z-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

Cascadia Community College

(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
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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: Chapter 28B.50 RCW. 96-14-098, § 132Z-276-140, filed 7/2/96, effective 8/2/96.]