Grand Island Public Schools
9230.1 Request for Records/Information
Name: ____________________
Date: ____________________
Address: ____________________
What information or record(s) are you requesting? (Please be specific.)
Signature of Individual Making Request ____________________
Office Use Only
Date request received: ____________________
Request approved ____________________
Date request completed: ____________________
Request denied ____________________
Reason for denial (as per Neb. Rev. Stat. 84-712.04): ____________________
Superintendent or Designee ____________________
Date ____________________
