Foia-Request For Public Records Form
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1Northern Illinois University
REQUEST FOR PUBLIC RECORDS
Under the Illinois Freedom Of Information Act
**Note to Requestor: Retain a copy of this request for your files. If you eventually need to file a Request for Review
with the Public Access Counselor, you will need to submit a copy of your FOIA request.**
Requestor's Name
Date Requested
Company/Agency Name
Telephone #
Area Code (
)
--
Address (Street And Number)
Cell Phone #
Area Code (
)
--
City
State
Zip
E-mail Address
Do you want copies of the documents? Yes
No
Do you want Electronic Copies (if Available), or Paper Copies? _____________________________
If you want Electronic Copies, in what format? _______________________________
Records Requested: *Provide as much specific detail as possible so the public body can identify the information that you
are seeking. You may attach additional pages if necessary.
Request Type:
Contracts & Agreements
Police Report
Purchasing Documents
Other
If you are requesting a police report, please provide:
Date of Incident Report:
Location of Incident:
Is this request for Commercial Purpose?
Yes
No
(It is a violation of the Freedom of Information 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. 5 ILCS 140/3.1(c))
Are you requesting a fee waiver? Yes
No
(If you are requesting that the public body waive any fees for copying the documents, you must attach a statement of
the purpose of the request, and whether the principal purpose of the request is to access or disseminate information
regarding the health, safety and welfare or legal rights of the general public. 5 ILCS 140/6(c))
- Please complete the form and mail, fax, email, or hand deliver directly to one of NIU's FOIA Officers. To submit
this form electronically you must save it to your computer then e-mail to the officer. Information on where to submit
your FOIA request is available online at:
- Copy Fees: For black and white, letter or legal sized copies, the first 50 pages are free, any additional pages will be
charged at .15 cents per page. Color and abnormal size copies will be charged the actual cost of copying.
FOR OFFICE USE ONLY:
Date Request Received: _______________________________ Date Response Due : __________________________________
Request Fowarded to : ___________________ Date :_________ Copying Fee Received. Date : _______________________
Amount: $ ___________ Cash _____ Check # ________
Revised 7/10
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