506.1E3 - Request for Hearing on Correction of Education Records

 

Address:

 

 

Board Secretary (Custodian)

 

 

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: