File for access to the School Districts records, under the Freedom of Information Act.
This page needs to be re-done in PDF.
THREE VILLAGE CENTRAL SCHOOL DISTRICT
Box 9050
East Setauket, New York 11733-9050
APPLICATION FOR PUBLIC ACCESS TO RECORDS
APPLICATION MUST BE FILED FIVE (5) WORKING DAYS IN ADVANCE
TO: RECORDS ACCESS OFFICER
Board of Education
Three Viliage Central School District
Box 9050
East Setauket NY 11733-9050
I hereby apply to ( )inspect only or ( )inspect and request reproduction @ 25 cents per page, the following
record(s):
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
NAME OF APPLICANT: ____________________________________ TELEPHONE NO: ___________________
(Please Print)
ADDRESS: ___________________________________________________________
__________________________________________________ _________________
Signature of Applicant Date of Application
I hereby acknowledge receipt of the reproduction of records.
Representing: _____________________________________
Mailing Address: ____________________________________________________________
Date: _______________ Signature: _____________________________________________
___________________________________________________________________________________________________________________
FOR OFFICE USE ONLY
Approved
Denied (for the reason(s) below)
( ) Confidential disclosure
( ) Part of investigatory files
( ) Unwarranted invasion of personal privacy
( ) Record of which this agency is legal custodian cannot be found
( ) Record is not maintained by this agency
( ) Exempted by statute other than the Freedom of Information Act
( ) Other (specify) __________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Signature Title Date
NOTICE: You have a right to appeal a denial of this application to the Superintendent of Schools of the Three
Village Central School District. Please submit such appeal in writing to the Superintendent, who MUST then
respond within ten days of the receipt of the appeal.
Note: Refer to policy 1120 and regulation 1120-1R for more information.
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