request for public record to committee on advanced tuition payment | ||
(a). . . . | ||
Name (please print) | Signature | |
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Name or Organization, if applicable | ||
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Mailing Address of Applicant | Phone Number | |
(b). . . . | ||
Date Request Made | 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 Committee on Advanced Tuition Payment Index | ||
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Request: approved. . . . | denied. . . . | Date. . . . |
By. . . . | ||
Name | Title | |
Reasons for Denial:. . . . | ||
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Referred to. . . . | Date. . . . | |
By. . . . | ||
Name | Title |