CLICK HERE TO DOWNLOAD REQUEST FOR HEARING ON CORRECTION OF EDUCATION RECORDS
To: (Name of Student Attendance Center) _____________________________________
Address (Of Student Attendance Center) _____________________________________
As the ____________________________________(Relationship to Student) of ____________________________(Student Name)
I believe the district’s official education records are inaccurate, misleading, or in violation of
privacy or other rights of this student.
The official education records which I believe are inaccurate, misleading, or in violation of the privacy or other rights of this student are: (Please be specific): _____________________________________________________________________________________
The reason I believe such records are inaccurate, misleading, or in violation of the privacy or other rights of this student is: (Please share your reasons, be specific as possible):______________________________________________________________________________
I understand that I will be notified of the date, time, and place of the hearing; that I will be notified in writing of the district’s decision; and that I have the right to appeal the decision by notifying the superintendent in writing within 10 days after my receipt of the decision. I further understand that if the request to amend the student’s education record is denied, that I have the right to place an explanatory letter in the student’s education record stating I disagree with the district’s decision and why.
Signature: _____________________________________ Date: ____________________________________
Address: ________________________________________ City: ________________________ State:______
Zip: ___________ Phone Number: ___________________________________
Adopted: 9/98
Reviewed: 7/13; 10/14; 12/20; 10/23
Revised: 8/07; 8/17; 10/19
Related Policy: 505.6; 505.6-R; 505.6-E2-E3; 505.6-E5-E7
IASB Reference: 506.01-E(3)