506.1E5 - Notification of Transfer of Education Records

To:                                                                                                              Date:                                      

Address:                                                                                                                                                   

City / State:                                                                                              Zip:                                            

   

Please be notified that copies of the                                                                Community School District's official education records concerning                                            , (full legal name of student) have been transferred to:

School District Name                                                                                               Address                                                                                   

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)