Persons requesting access to student library circulation records shall submit the following information to the building administrator.
Date: __________________________ Name: __________________________________________
Title: ___________________________________________
Student(s) Records Requested: ______________________________________________________________
_______________________________________________________________________________________
Purpose for Access: ______________________________________________________________________
_______________________________________________________________________________________
Number of Copies Requested: ____________________
Signature of Person Requesting Access: ______________________________________________________
Request Approved: __________ Denied: __________ Fee Paid: __________
By: ________________________________ _______________________________ _____________
Building Administrator Name Building Administrator Signature Date
