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2. First Name *
3. Last Name *
5. Address1 *
7. Address2
9. City *
10. State
11. Zip *
13. Email *

    Please provide a valid email address to where you would like electronic records delivered. 

14. Phone Number *

    Please provide a valid phone number where you can be reached. 

18. Records Requested *

    Please describe the record you are requesting. Be as specific as possible and include enough detail to assist SHRC staff in locating the proper record(s).

20. Format of Record(s) *

    1. Paper Copy
    2. Electronic Copy
    3. Visual Inspection Only

    Please specify the preferred format of record(s). 

24. Electronic Acknowledgement *

    By typing your name in this box, you certify that the information IS true and correct to the best of your knowledge. 

25. Date *
27. Information Disclosure

    SHRC will respond to the requester acknowledging the request within 24 hours of receiving the request. 

    All requests will be available with 3 days of the original request. 

    For more information on public records, please visit  https://ag.ks.gov/open-government/kora-faq

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28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit