The district hereby adopts for use by all persons requesting inspection and/or copying or copies of its records the following form:

REQUEST FOR PUBLIC RECORD TO

RENTON TECHNICAL COLLEGE

(1)	. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name (please print)		. . . . Signature
	. . . . Name or Organization, if applicable
	. . . . Mailing Address of Applicant		. . . . Phone Number
(2)	. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date Request Made		. . . . . . . . . . . . . . Time of Day Request Made
(3)	Identification Reference on Current Index (Please describe)
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(4)	Description of Record, or Matter, Requested if not Identifiable by Reference to the Renton Technical College Index
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(5)	(If request covers a list of individuals:) The undersigned records requester certifies and declares under penalty of perjury under the laws of the State of Washington that no list or names of individuals obtained through this request will be used for any commercial purpose:
Requested By . . . . . . Date . . . . . Time. . . .
Received By . . . . . . . Date . . . . . Time. . . .
action on request
Request: approved . . . .		denied. . . .		Date . . .
By . . . . . . . . . . . . . . . . . . . Name		. . . . . . . . . . . . . . . . . . . . . . . . . Title
Reasons for Denial: . . . .
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