506.1E3 - Request for Hearing on Correction of Student Education Records

To:       _____________________________________     Address:______________________________
               Board Secretary (Custodian)

 

I believe certain official education records of my child,____________________________________ , (full legal name of student), ___________________________________________(school name), are inaccurate, misleading or in violation of privacy rights of my child.

 

The official education records which I believe are inaccurate, misleading or in violation of the privacy or other rights of my child are:

 

 

The reason I believe such records are inaccurate, misleading or in violation of the privacy or other rights of my child is:

 

 

My relationship to the child is:

 

I understand that I will be notified in writing of the time and place of the hearing; that I will be notified in writing of the decision; and I have the right to appeal the decision by so notifying the hearing officer in writing within ten days after my receipt of the decision or a right to place a statement in my child's record stating I disagree with the decision and why.

 

                                                                        ____________________________________________

(Signature)                                                                                                        

Date:                                                                                                                 

Address:                                                                                                           

City:                                                                                                                  

State:              ZIP:                    

Phone Number: