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Texas Government Code Section 552.024 Public Access Option Form

  1. Please enter your full name.

  2. The Public Information Act allows certain current and former government employees and/or officials to elect whether to keep certain information confidential. Unless you choose to keep it confidential, the following information about you may be subject to public release if requested under the Texas Public Information Act. 

    Therefore, please indicate whether you wish to allow public release of the following information.

    Public Access?

  3. Home address*
  4. Email address*
  5. Home telephone number*
  6. Cellular telephone number*
  7. Social Security Number*
  8. Emergency contact information*
  9. Information that reveals whether you have family members*
  10. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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