505.6-E2 - Request of Non-Parent for Examination or Copies of Education Records

CLICK HERE TO DOWNLOAD REQUEST FOR NON-PARENT FOR EXAMINATION OR COPIES OF EDUCATION RECORDS


The undersigned hereby requests permission to examine the Linn-Mar Community School District’s official education records of:

Legal Name of Student: _________________________________________________

Date of Birth: __________________________________________________________


The undersigned requests copies of the following official education records of the above student:

The undersigned certifies that they are: (check one)

_____An official of another school system in which the student intends to enroll.

_____An authorized representative of the Comptroller General of the United States.

_____An authorized representative of the Secretary of the US Department of Education or US Attorney General.

_____A state or local official to whom such is specifically allowed to be reported or disclosed.

_____A person connected with the student's application for, or receipt of, financial aid.
          (Specify details: ______________________________________________________)

_____Otherwise authorized by law. (Specify details: _____________________________________________________)

The undersigned agrees that the information obtained will only be re-disclosed consistent with state or federal law without the written permission of the parents of the student or the student if the student is of majority age.

Signature: ______________________________________ Date: __________________________________

Title: ___________________________________________ Agency: _______________________________

Address: ________________________________________ Phone Number: _________________________

Approved:

Signature: ____________________________ Title: ______________________ Date: __________________


Adopted: 9/98
Reviewed: 7/13; 10/14; 12/20; 10/23
Revised: 8/97; 8/17
Related Policy (Code#): 505.6; 505.6-R; 505.6-E3-Ey
IASB Reference: 506.01-E(1)