Freedom of Information Act (FOIA) Request

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Requester Name*

Day Telephone*

Company/Organization*

Address*

Street Address City State Zip Code

Email*

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Records Requested*

(Please be specific, include approximate date range, record type, etc.)

Are you asking for these records for commercial purposes?

Yes

Please indicate the format in which you would like the District to respond:*

I request electronic copies be sent to the email address above if possible or be referred to the District website.

I request hard copies of these records. I agree to pay the fees (if any) for copies as set by the fee schedule below, prior to receiving the copies. (a) Black and white, letter or legal size copies: There is no charge for the initial 50 pages, after which the cost will be $.15 per page. (b) For Color or Irregular Sized Copies: The fee for color or irregular sized copies shall be the actual cost incurred by the District for reproducing the records, as determined by the FOIA Officer. (c) Certification of document: The fee for certification of a document shall be $1.00. (d) Records in Electronic Format: The fee charged for producing records in an electronic format shall be the actual cost incurred by the District for purchasing the recording medium.

I request certification of the copies provided. I agree to pay $1.00 for each document certified, which is in addition to duplication fees (if any).

(Please Check)

By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.*

I agree

Electronic Signature*

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