Wash. Admin. Code § 132G-276-900
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 . . . . . . . . . . .. | ||||
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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 Shoreline Community College's Current Index . . . . . . . . . . .. | ||||
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(f) | Purpose of Request if the Request is for a List of Individuals . . . . . . . . . . .. | ||||
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Request: Approved . . . . . . . . . . .. | By . . . . . . . . . . .. | ||||
Date | Public Records Officer or his or her designee | ||||
Denied Date . . . . . . . . . . .. | |||||
Reasons for Denial: . . . . . . . . . . .. | |||||
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Referred to . . . . . . . . . . .. | Date . . . . . . . . . . .. | ||||
By . . . . . . . . . . .. | |||||
Public Records Officer or his or her designee | |||||
Wash. Admin. Code § 132G-276-900
Statutory Authority: RCW 28B.50.140(13) and 42.17.260(5). 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.