|
|
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: |
|
|
|
|||||||||||
