Mississippi Public Universities
Request for Public Records
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Date of Request: 7/30/2016
   
Person Requesting:
Required
   
Representing:
   
Mailing Address:
   
City:
   
State:
   
ZIP:
   
Primary Telephone:
   
Secondary Telephone:
   
Primary Email:
Required: Due to technical restrictions, please do not use a Yahoo.com email address as your primary email. Do not enter more than one email address. Use the Secondary Email Address field for an optional email address.
   
Secondary Email:
   
Material Requested (Please be as clear and concise as possible.):
   
Review Requested:  Personally Inspect
   Copy of Material
   
Material Provided Via:  Electronic Mail
   Postal Service Mail
   
Additional Instructions:
   
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Note: Actual costs of gathering and reproducing requested materials will be the responsibility of the requesting agent.
You may download a printable version of this form for offline submission.