174-276-100 - Form - Request for public records

174-276-100. Form - Request for public records

REQUEST FOR PUBLIC RECORDS

The Evergreen State College

Section I - IDENTIFICATION. The information requested in Boxes 1 through 4 is not mandatory. If provided, it will allow the Records Officer to contact you, if necessary, in connection with your request.

  

DATE

1. Name of Requester

2. Representing (if applicable)

3. Street Address

     

4. City-State-Zip Code

If there is any particular urgency

attached to this request, please

indicate the date by which

you need the information.

Section II - NATURE OF REQUEST. Please be specific about the records you wish to see. If you do not know the name of the records, make your request in the form of a question. To comply with RCW 42.17.260(5) (noncommercial use), please sign the certification below.

I certify that the information obtained as a result of this request for public records will not be used in whole or in part to compile a list for commercial purposes.

                 

. . . . . . . . . . . .

                 

Requester's Signature

DO NOT FILL IN BELOW THIS LINE

Section III - REQUEST FOR REVIEW

Requested by

     

Office

        

Telephone

Section IV - DISPOSITION OF REQUEST

1.

  

2.

     

3.

        

4.

5.

     

6.

     

7.

        

8.

  

9.

Statutory Authority: Chapter 34.05 RCW. 90-04-011, § 174-276-100, filed 1/26/90, effective 2/26/90.

The following state regulations pages link to this page.