Freedom Of Information Act Request Form - District 158
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1Consolidated School District 158
2:250-F1
Revised 8/18/11
Freedom of Information Act Request
Superintendent’s Office
All requests must be made in writing and can be submitted via letter, facsimile, e-mail, or a personal visit to the District 158
Administration Offices. Forms can be faxed to (847) 659-6121, emailed to or mailed/dropped off to
650 Academic Drive, Algonquin, IL 60102.
This form has been created and is made available for convenience purposes only. Completion of this form is not required.
______________________________________________
______________________________________________________
Date of Request
Name of Requestor (please print)
______________________________________________
______________________________________________________
Name of Organization / Business (if applicable)
Mailing Address of Requestor
______________________________________________
______________________________________________________
Daytime Telephone Number
City, State and Zip
Pursuant to the Freedom of Information Act, 5 U.S.C. 552, and the Privacy Act, 5 U.S.C. 552a, Privacy Act, 5 U.S.C. 552a),
I hereby request access to the records listed below. Describe in detail the subject or document(s) containing the information
requested – be as specific as possible.
Will the information requested be used for commercial purposes?
Yes
No*
* (5 ILCS 140/3.1) Sec. 3.1. Requests for commercial purposes. (c) It is a violation of this Act for a person to knowingly obtain a public record
for a commercial purpose without disclosing that it is for a commercial purpose, if requested to do so by the public body.
The first 50 pages for black and white, letter or legal sized copies (8½ x 11 or 11 x 14), are available free of charge. A fee of .05¢
per page, which is reasonably calculated to reimburse the District for the actual costs of reproducing or certifying the public
records, will be charged for copies exceeding 50 pages. A fee for reproducing CDs/DVDs (.50¢ per CD/DVD) will be charged.
Such fees shall be set annually by a School Board resolution within the guidelines of the Illinois Freedom of Information Act laws.
If any expenses in excess of $___________ are incurred in connection with this request, please obtain my approval before any
charges are incurred.
I request a waiver of fees as disclosure will contribute to public understanding of the operations or activities of the
government because (state reason below):
_________________________________________________________________________________________________________
The District will respond to your request within five (5) business days (21 business days for commercial requests) as
provided by law. If your request is denied in whole or in part, justification for withholding the records will be provided to
you. Any segregated portions that are not exempt will also be disclosed to you.
___________________________________________________
Signature of Requestor
Upon completion of my request:
Call me at the number listed above
Mail response to address listed above
Email response to: _________________________________________
Fax response to: ________________________
S:\Supt_Adm\Policy\Forms\Section 2\Freedom of Information Act Request 2.250 F1.doc
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