506.1E4 - Request for Examination of Education Records

506.1E4 - Request for Examination of Education Records

EDUCATION RECORDS ACCESS-

REQUEST FOR EXAMINATION OF EDUCATION RECORDS

Code No.  506.1E4

To:

 

 

 

 

Address:

 

 

Board Secretary (Custodian)

 

 

 

 

 

 

 

 

 

The undersigned desires to examine the following official education records.

of

 

,

 

 

 

(Full Legal Name of Student)

 

(Date of Birth)

(Grade)

(Name of School)

 

 

My relationship to the student is:

 

(check one)

 

 

 

 

 

I do

 

 

 

 

 

 

I do not

 

 

 

desire a copy of such records.  I understand that a reasonable charge may be made for the copies.

 

 

 

 

 

(Parent's Signature)

 

 

APPROVED:

 

Date:

 

 

 

 

 

 

 

Address:

 

 

Signature:

 

 

City:

 

 

Title:

 

 

 

State:

 

ZIP

 

Dated:

 

 

 

Phone Number:

 

 

                                           

Reviewed:  04/22/2024

Revised:

dawn.gibson.cm… Wed, 07/14/2021 - 15:36