REQUEST FOR HEARING ON CORRECTION OF STUDENT RECORDS
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To:
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Address:
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Board Secretary (Custodian)
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I believe certain official student records of my child, , (full legal name of student), (school name), are inaccurate, misleading or in violation of privacy rights of my child.
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The official education records which I believe are inaccurate, misleading or in violation of the privacy or other rights of my child are:
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The reason I believe such records are inaccurate, misleading or in violation of the privacy or other rights of my child is:
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My relationship to the child is:
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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.
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(Signature)
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Date:
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Address:
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City:
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State:
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Phone Number:
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