Jt. Jerome School District #261 

COMMUNITY RELATIONS 4260F

District Record Request Form

Request for Public Records

I request:    ⬜ to examine      ⬜ to copy       ⬜ to receive an electronic copy 

of the following records (please be as specific as possible):

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Date Records Requested Were Created:

Beginning: ________________________________________________________________

Ending: ___________________________________________________________________

Name (Please Print) __________________________________________________________________

Mailing Address:_______________________________________________________________________________

Under oath, and with the understanding of the possible penalty of perjury should I provide untruthful information, I affirm that I am:

_____ A resident of the State of Idaho. I have resided in Idaho for at least the last 30 days or I am making this request on behalf of a domestic entity as provided in IC 30-21-102. I am not a full-time student who is a resident of another state.

Identification of Idaho Domestic Entity if request is being made on behalf of such entity:

Name of Idaho Domestic Entity: __________________________________________

Address: _____________________________________________________

Position held by person making request on behalf of Idaho Domestic Entity:_________________________

OR

_____ I am not a resident of the State of Idaho or an employee of a resident as described above.

Date of Request: ____________________________

Daytime Phone Number: _____________________________________________

Received By: __________________________________________

Date Received: __________________________________________

Public Agency __________________________________________

Request by an Idaho Resident or Their Employee

_____ Initial if Applicable: More than three working days are needed to locate or retrieve the requested records. A response shall be provided within ten working days of the request. unless the field below has been initialed.

_____  Initial if Applicable: The record requested must be converted from one electronic format to another and doing so will require more than ten working days. The agency shall provide the converted public record at the following time, which has been mutually agreed upon between the agency and the requester, with due consideration given to any limitations that may exist due to the process of conversion or due to the use of a third party to make the conversion: ____________________

Request by Someone Who is Not an Idaho Resident or Their Employee

_____ Initial if Applicable: More than 21 days are needed to locate or retrieve the requested records. A response shall be provided within 35 days of the request. unless the field below has been initialed.

_____  Initial if Applicable: The record requested must be converted from one electronic format to another and doing so will require more than 35 days. The agency shall provide the converted public record at the following time, which has been mutually agreed upon between the agency and the requester, with due consideration given to any limitations that may exist due to the process of conversion or due to the use of a third party to make the conversion:

____________________________ ______________________________________________________

Date of Request Daytime Phone Number

Payment Received for________________ Copies________________ Amount Received _____________

Payment Received for__________________ Labor___________________ Amount Received______________

________________ ___________________

Receipt Number                     Date

Policy History:

Adopted on: 09/27/2011

Revised on: 12/15/2015

Revised on: 01/26/2021

Revised on: 02/28/2023

Revised on: 05/26/2026