APPENDIX "A"

REQUEST FOR PUBLIC RECORD TO

COLLEGE DISTRICT NO. 10

(a)	. . . . Signature		. . . . Signature (Please Print)
	. . . . Name of Organization, if Applicable
	. . . . Mailing Address of Applicant				. . . . Phone Number
(b)	. . . . Date Request Made at College District No. 10				. . . . 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 College District No. 10's Current Index . . . .
	. . . .
	. . . .
	. . . .
Request: Approved . . . .				By . . . .
		Date		Public Records Officer
Denied Date . . . .
Reasons for Denial
. . . .
. . . .
Referred to . . . .		. . . .		By . . . .
		Date		Public Records Officer

[Statutory Authority: RCW 28B.50.140 and 34.02.353 [34.05.353]. WSR 15-15-071, § 132J-276-900, filed 7/13/15, effective 8/13/15; Order 73-2, Appendix A (codified as WAC 132J-276-900), filed 5/14/73.]

PDFWAC 132J-276-900

Appendix "A"—Request for public record to College District No. 10.