505.01 E5 - Request of Parent for Examination or Copies of Student Records

To:                                                                   Address:                                                         
            Board Secretary (Custodian)

 

The undersigned desires to examine the following official education needs:

                                                                                                                                                

                                                                                                                                                

                                                                                                                                                

of                                                                                 ,                                                          
            (Full Legal Name of Student)                        (Date of Birth)            (Grade)

 

                                                                                                                                               
(Name of School)

 

My relationship to the student is:                                                                                          

 

(check one)

                                     I do

                                     I do not

desire a copy of such records.  I understand that a reasonable charge may be made for the

copies.

 

                                                                                                                                                
Signature                                                         Parent’s Signature

 

                                                                                                                                               
Title                                                                 Date

 

                                                                                                                                               
Date                                                                Address

 

                                                                                                                                               
                                                                        City

 

                                                                                                                                               
                                                                        State                                        Zip Code

 

                                                                                                                                               
                                                                        Phone Number

 

 

(January 17, 2005; March 21, 2011; January 19, 2015; August 19, 2019)