Southern Illinois University Edwardsville Record Request Form: Illinois Freedom Of Information Act printable pdf download

Southern Illinois University Edwardsville Record Request Form: Illinois Freedom Of Information Act

Office

Office Use Only. Request received by:_________________________, ______________________________

(unit)

(person accepting)

Request received:____________________________, ______________________________

)

(date)

(time

SOUTHERN ILLINOIS UNIVERSITY EDWARDSVILLE

RECORD REQUEST FORM: ILLINOIS FREEDOM OF INFORMATION ACT

I submit this request for records from Southern Illinois University Edwardsville under the

provisions of the Illinois Freedom of Information Act.

Requestor Information. Name:___________________________________________________

Current mailing address:________________________________________________________

Daytime telephone:________________________ Email address: ________________________

Description of Records Requested. (Please provide as complete a description of the records

requested as possible, for example, title or subject of document/record, date of issue, person or

office issuing the document/record, person or office receiving the document/record, and so

forth).

____________________________________________________________________________

____________________________________________________________________________.

Type of Request (check as appropriate). This request is to: ____ inspect the record(s), ___

obtain a copy of the record(s), or, ____ obtain a certified copy of the record(s).

______________________________________

___________________________________

(Signature of Requestor)

(Date)

RECORD REQUESTORS PLEASE NOTE: This form may be reproduced if additional copies

are needed.

Southern Illinois University Edwardsville Record Request Form: Illinois Freedom Of Information Act