Central Oregon Community College
2600 NW College Way
Bend, OR 97703
541-383-7596
PUBLIC RECORD(S) REQUEST
(See “Guidelines for Public Records Requests” COCC Procedures B-2-0 for additional instructions.)
Parties requesting public records are encouraged to complete the Public Record(s) Request form and submit
it, accompanied by a check made out to “Central Oregon Community College in the amount of $25, to the
Director of College Relations. This will allow the College to contact you for clarification of your request and
notify you when the records are available for pickup. Requests will be accepted or denied in accordance
with the College’s Guidelines for Public Records Requests (COCC Procedures B-2-0).
______________________________________ _____________________________
Name of Requesting Party (i.e., business name) Date
MAILING ADDRESS OF REQUESTING PARTY:
______________________________________ _____________________________
Street City
____________________ ____________ _____________________________
State Zip Telephone
______________________________________
E-Mail Address
For special consideration by the college in waiving or reducing the total fee, provide nonprofit 501(c)3 status,
if applicable. Indicate # ______________________________________________________.
Preferred method of obtaining public records (please make your preference known by initialing)
______ Requesting party will pick up.
______ College will deliver via U.S. Postal Service.
______ College will deliver to email address above.
It is to everyone's advantage if requests are as precise and as narrow as possible. The requester benefits
because the request can be processed more quickly and inexpensively. The college benefits because it can
do a better job of responding to the request. The Oregon Public Records laws work best when both the
requester and the college act cooperatively.
What public record(s) are you requesting? (Please specify.)
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
I certify that the statements contained in this form are true and correct to the best of my knowledge and belief,
that I have read and understand the Central Oregon Community College Guidelines for Public Records
Requests, and that I have attached the required $25 deposit with this formal request. (Where fees are waived
or request is denied, College will promptly return deposit payment.)
____________________________________________
Name of Individual Requesting Records (please print)
____________________________________________ ________________________
Signature of Individual Submitting Request for Records Date
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