FOR PUBLIC RECORDS
STAFF USE ONLY
Request was made (check one)
q by requester on this form
q by telephone
q in writing other than on form
(attach original request)
Date Response Sent: ____________
q Identification Verified
q Itemized Cost Estimate Attached
E-mail address __________________________
I am a (check one):
q Citizen of the Commonwealth of Virginia
q Member of the Press referenced in Va. Code §2.2-3704
News Organization ____________________
Requesters may be asked to provide verification that they are citizens of the Commonwealth or a member of the press referenced in Va. Code § 2.2-3704.
I am requesting access to the following records (please be as specific as possible, and attach additional paper if necessary _______________________________________________
Reasonable costs may be assessed in connection with this request. A current schedule of costs appears in Regulation KBA-R Requests for Public Records. If the costs associated with this request are expected to exceed $200, the requestor will be asked to pay the estimated costs before the request is processed.
In addition, the requestor may ask for an advance determination of the cost of the request. Please indicate here if you would like an advance determination of cost.
Yes ___ No ___
If you are requesting copies, please specify the format in which you would like to receive them. Alleghany County school division will provide the record(s) in the requested format if that medium is used by it in the regular course of its business.
Specify format desired (if available):
q E-mail (give address): ___________________
q Website posting
q Other (please specify): ___________________
RETURN COMPLETED FORM TO:
Alleghany County Public Schools
Office of the Superintendent
100 Central Circle
Low Moor, Virginia 24457
Phone: (540) 863-1800 / Fax: (540) 863-1804