To: _______________________________________ Date: ______________________
Parent/Guardian
Street Address:_____________________________________________________________
City/State:________________________________________ Zip:_____________________
Please be notified that copies of the Central City Community School District's official education records concerning, ____________________________________________ (full legal name of student), have been transferred to:
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School District Name |
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upon the written statement that the student intends to enroll in said school system.
If you desire a copy of such records furnished, please check here _____ and return this form to the undersigned. A reasonable charge will be made for the copies.
If you believe such records transferred are inaccurate, misleading or otherwise in violation of the privacy or other rights of the student, you have the right to a hearing to challenge the contents of such records.
________________________________________________
Name
________________________________________________
Title
Approved: 3/15/10
Reviewed: 4/22/15
Revised:6/24/20
