Name of Requesting Party (i.e., business name) Date
MAILING ADDRESS OF REQUESTING PARTY:
____________________ ____________ _____________________________
State Zip Telephone
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