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Right to Know Request Form
Date Requested:
Request Submitted By
Name of Requester:
Street Address:
City/State/County/Zip:
(Required)
Telephone (Optional) E-Mail (Optional)
Record/s Requested:
*Provide as much specific detail as possible so the agency can identify the information.
Do you Want Copies? Yes or No
Do You Want to Inspect The Records? Yes or No
Do You Want Certified Copies of Records? Yes or No
*For internal use only
Right to Know Officer:
Date Received by t
he Agency:
Agency Five (5)-Day Response Due:
**Public bodies may
fill anonymous, verbal or written requests. If the requester wishes to pursue the relief and
remedies provided for in this act, the request must be in writing. (Section 702.) Written requests need not include
an explanation why information is sought or the intended use of the information unless otherwise required by law.
(Section 703.)
Delaware County Community College, 901 S. Media Line Rd., Media, PA 19063
Phone: 610-359
-5305 Fax: 610-359-5125
