To: Date: Parent/or Guardian
Street Address:
City/State: Zip:
Please be notified that copies of the
Community School District’s official student records concerning
(full legal name of student) have been transferred to:
School District Name Address
upon the written statement that the student intends to enroll in said school system.
If you desire a copy of such records furnished, please check here ______ and return
this form to the undersigned. A reasonable charge will be made for the copies.
If you believe such records transferred are inaccurate, misleading or otherwise in
violation of the privacy or other rights of the student, you have the right to a hearing
to challenge the contents of such records.
Name
Title
(January 17, 2005; March 21, 2011; January 19, 2015; August 19, 2019)