Name:*

	Please fill in your location:*
	Street:   City:   State:   Zip: Address:

	Date:*

	Phone:

	Email:*

	Nature of Request
	Opportunity to review records. (No original record may leave the custodian's office.)    Copies of Records

	Please read and sign the following statement: I have requested public records of the school district for a noncommercial purpose. I understand that if the records should be used for a commercial purpose, a verified statement of the purpose must be submitted per A.R.S. 39-121.03. Typing your name below acts as your signature and indicates you have read and understand this statement.*

	Notice: A fee will be charged for copying based upon actual cost for providing the information.

	Records Requested (Please be as explicit as possible as to the records you desire.)