REQUEST FOR HEARING ON CORRECTION OF EDUCATION RECORDS
To:____________________________________ 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: ______________________
Approved: October 14, 2024
Reviewed: January 17, 2005; March 21, 2011; January 19, 2015; August 19, 2019; October 14, 2024
Revised: October 14, 2024