PDFWAC 132G-276-900
Appendix A—Form—Request for public record to the Shoreline Community College.
APPENDIX "A"
REQUEST FOR PUBLIC RECORD TO
SHORELINE COMMUNITY COLLEGE
(a) | . . . . Name (Please Print) | . . . . . . . . . . . . . Signature | |||
. . . . Name of Organization, if Applicable | |||||
. . . . Mailing Address of Applicant | . . . . . . . . . . . . . Phone Number | ||||
(b) | . . . . Date Request Made at the Shoreline Community College | . . . . . . . . . . . . . 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 Shoreline Community College's Current Index . . . . | ||||
. . . . | |||||
. . . . | |||||
. . . . | |||||
(f) | Purpose of Request if the Request is for a List of Individuals . . . . | ||||
. . . . | |||||
. . . . | |||||
. . . . | |||||
Request: Approved . . . . | By . . . . | ||||
Date | Public Records Officer or his or her designee | ||||
Denied Date . . . . | |||||
Reasons for Denial: . . . . | |||||
. . . . | |||||
Referred to . . . . | Date . . . . | ||||
By . . . . | |||||
Public Records Officer or his or her designee |
[Statutory Authority: RCW 28B.50.140(13) and 42.17.260(5). WSR 00-10-048, § 132G-276-900, filed 4/26/00, effective 5/27/00; Order 3-11:74, Appendix A (codified as WAC 132G-276-900), filed 4/26/74.]