170235E
Freedom of Information
Request to Inspect Records
To: Jessica Crotty
Assistant Director of Communications
Moraine Valley Community College
9000 W. College Pkwy.
Palos Hills, IL 60465
From: (Please Print)
Name___________________________________________________________________________________________________________________
Address________________________________________________________________________________________________________________
City, State, Zip Code_____________________________________________________________________________________________________
Telephone_______________________________________________________________________________________________________________
Email (Required) _________________________________________________________________________________________________________
I hereby request the opportunity to:
inspect or copy the following record(s):
_________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
Is information for commercial use? yes no
Describe record(s) precisely _______________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
I also request that a copy of the following record be certifi ed: ______________________________________________________________
________________________________________________________________________________________________________________________
Describe record _________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
A charge for copying will be assessed at the rate of $.15 per page; however, no charge will be assessed when the total number of
copies is fewer than 50 for black and white, letter or legal-sized copies.
_______________________________________________________ ________________________________________________________
Date request submitted Signature
