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Records Destruction Reporting Form

DATE: / /
Name:

Department:
If you choose "Other", please specify:

Campus Address:

Campus Phone:

Email Address:

Records Series Name:

U#:

Inclusive Years: -

cubic feet inches or electronic file size

Records Series Name:

U#:

Inclusive Years: -

cubic feet, inches or electronic file size

Records Series Name:

U#:

Inclusive Years: -

cubic feet, inches or electronic file size

Records Series Name:

U#:

Inclusive Years: -

cubic feet, inches or electronic file size

Thank you for your report. As long as you have determined that the retention period for these records has expired, they may be destroyed. Unless we have a question about your report, you will not receive an acknowledgment.

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