Appendix A—Request for public record to state board for community and technical colleges.

appendix "a"
request for public record to
state board for community and technical colleges
(a)
. . . .
. . . .
 
Signature
Signature (Please Print)
 
. . . .
 
 
 
Name of Organization, if Applicable
 
 
 
. . . .
. . . .
 
Mailing Address of Applicant
Phone Number
(b)
. . . .
. . . .
 
Date Request Made at State Board for Community and Technical Colleges
Time of Day
Request Made
(c)
Nature of request . . . .
 
. . . .
 
. . . .
 
. . . .
(d)
Identification Reference on Current Index . . . .
 
 
Please Describe
 
. . . .
 
. . . .
 
. . . .
(e)
Description of Record, or Matter, Requested if not Identifiable by Reference to the State Board for Community and Technical Colleges Index . . . .
 
. . . .
 
. . . .
 
. . . .
 
. . . .
Request: Approved
. . . .
By . . . .
 
 
Date
Public Records Officer
Denied Date . . . .
 
Reasons for Denial: . . . .
. . . .
. . . .
Referred to . . . .
Date . . . .
 
 
 
By . . . .
 
 
 
Public Records Officer
[Statutory Authority: Chapter 28.50 [28B.50] RCW. WSR 98-23-052, § 131-276-990, filed 11/13/98, effective 12/14/98; Order 18, Appendix A (codified as WAC 131-276-990), filed 7/2/73.]
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