(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 |