Public Records Request Form Step 1 of 4 25% This field is hidden when viewing the formNext Steps: Sync an Email Add-OnTo get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page (https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020/). Important: Delete this tip before you publish the form.Complete and submit this form to make a public records request. All fields must be completed with accurate information for the request to be processed. Payment of fees may be required before the request is fulfilled.Date of Request:(Required) MM slash DD slash YYYY Let’s collect some information.Name:(Required) First Last Phone Number:(Required)Email Address:(Required) Enter Email Confirm Email Your Address:(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Records RequestedPursuant to the §36-12-40, Code of Alabama 1975, Inspection and Copying of Records, “Every citizen has a right to inspect and take a copy of any public writing of this state, except as otherwise expressly provided by statute.” Please read the following carefully before submitting your records request(s).Select the area relating to your Public Records Request(Required)AcademicsCommunications and MediaData and ResearchInstitutional FinanceAgency (ACHE) FinancePolicy and ProcedureOtherBrief Purpose of RequestSpecify a Data or Date Range for the Requested RecordsDetailed description of Public Records Requested(Required)AttachmentMax. file size: 25 MB. Please list any news/media organizations you represent or on whose behalf you are submitting this request.(Required)All request responses will be provided in digital form when possible. If printed documents are required, please specify what type of documents are requested. Fees to be applied for locating, retrieving, and preparing records for production of public records requests are as follows: * Standard Requests: A response fee of $20 will be charged. * Time-Intensive Requests: A response fee of $20 plus $20 per hour will be charged. * Copying Records: A fee of $0.50 per page (8.5 x 11) will be charged. BY PRESSING SUBMIT, YOU ARE ACKNOWLEDGING THAT YOU HAVE READ AND AGREE WITH OUR RECORDS DUPLICATION POLICY AND ACCESS FEE SCHEDULE ABOVE.ACKNOWLEDGEMENT *(Required) I ACKNOWLEDGE THAT I HAVE READ AND AGREE WITH ACHE’S RECORDS DUPLICATION POLICY AND ACCESS FEE SCHEDULE ABOVE. CAPTCHA
