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									   Equal Opportunity Policy: Pflugerville                                                                   Pflugerville ISD
   Independent School District does not                                                                     Department of Policies and Procedures
   discriminate on the basis of race, religion,
   sex, age, national origin, marital or veteran                                                            1401 West Pecan
   status, or handicap in admission or access to,                                                           Pflugerville, TX 78660
   or treatment or employment in, its programs                                                              Phone: (512) 594-0085
   and activities in compliance with applicable                                                             Fax: (512) 594-0086
   federal and state laws.


                                                     Request for Public Information

Name:

Company:

Address:
                                                                                          City                          State                   Zip

Phone:                                                                                    Other Number:

Email:

               Information Requested under Texas Open Records Act: Check Items you are requesting

Student            Parent                                      All Student                          Employee
___ Name    ___ Parent Name                                information will be                      ___ Name
___ Address ___ Parent Phone                                   released in                          ___ Address
___ Phone                                                    accordance with                        ___ Phone
___ Grade                                                        FERPA                              ___ Campus
___ Campus                                                                                          ___ Subject Taught

Other Information Requested:




Payment is due upon delivery; please make checks payable to Pflugerville ISD. You will be contacted
once information is completed; you may come by our office to pick up Monday – Friday 8:00 - 4:30

_____ Copies of Documents – 10 cents per standard (8.5x11) page; 50 cents non-standard

_____ Excel Files on floppy disk or CD - $5.00

Please allow 10 working days for processing your order. It will be available at the Administration reception desk. Please
call 594-0085 to check order status. Because of confidentiality issues, we do not email files.

________________________________                                                          ____________________
       Signature of Requestor                                                                      Date

________________________________                                                          ____________________
  Public Information Officer Approval                                                              Date

For PISD Use Only: Request sent to:                                                                                      Date:
Please return request form and information request to Policies and Procedures. Our office will contact requestor and/or send information out.

								
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