506.1E3 - Request for Hearing on Correction of Education Records

To: Board Secretary (Custodian)                                                                                            

Address:                                                                                                                                

    

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: