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PDFWAC 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. . . .
 
. . . .
 
. . . .
(d)
Identification Reference on Current Index (Please describe)
 
. . . .
 
. . . .
 
. . . .
(e)
Description of Record, or Matter, Requested if not Identifiable by Reference to the Community College District No. 4
 
. . . .
 
. . . .
 
. . . .
Request:
APPROVED. . . .
DENIED. . . .
Date. . . .
By
. . . .
Name
. . . .
Title
Reasons for Denial: . . . .
. . . .
. . . .
Referred to. . . .
Date. . . .
By
. . . .
Name
. . . .
Title
[Statutory Authority: RCW 28B.50.140. WSR 89-11-024 (Order 89-07), § 132D-276-140, filed 5/11/89.]
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