NOTE: In most cases, a completed RTKL request form is a public record. Rev. 12.21.2018
More information about the RTKL is available at https://www.openrecords.pa.gov
COMMUNITY COLLEGE OF ALLEGHENY COUNTY
Right-to-Know Law Request Form
Good communication is vital in the RTKL process. Complete this form thoroughly and retain a copy; it is required
should an appeal be necessary. You have 15 business days to appeal after a request is denied or deemed denied.
Date of Request: __________________________________ Submitted via: □ Email □ U.S. Mail □ Fax □ In Person
PERSON MAKING REQUEST:
Name: ________________________________________________ Company (if applicable): ______________________________________
Mailing Address: ________________________________________________________________________________________________________
City: ____________________________ State: ________ Zip: ______________ Email: ____________________________________________
Telephone: ____________________________________________________ Fax: ____________________________________________________
How do you prefer to be contacted if the agency has questions?
□ Telephone □ Email □ U.S. Mail
RECORDS REQUESTED:
Be clear and concise. Provide as much specific detail as possible, ideally including subject
matter, time frame, and type of record or party names. Use additional sheets if necessary. RTKL requests should seek
records, not ask questions. Requesters are not required to explain why the records are sought or the intended use of the
records unless otherwise required by law.
___________________________________________________________________________________________________________________________
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DO YOU WANT COPIES?
□ Yes, electronic copies preferred if available
□ Yes, printed copies preferred
□ No, in-person inspection of records preferred (may request copies later)
Do you want certified copies
? □ Yes (may be subject to additional costs) □ No
RTKL requests may require payment or prepayment of fees. See the Official RTKL Fee Schedule for more details.
Please notify me if fees associated with this request will be more than □ $100 (or) □ $____________.
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ITEMS BELOW THIS LINE FOR AGENCY USE ONLY
Tracking: ____________________ Date Received: ____________________ Response Due (5 bus. days): ____________________
30-Day Ext.?
□ Yes □ No (If Yes, Final Due Date: ___________________) Actual Response Date: ____________________
Request was:
□ Granted □ Partially Granted & Denied □ Denied Cost to Requester: $_____________________
□ Appropriate third parties notified and given an opportunity to object to the release of requested records.
