Exhibit 506.01-E(4): Education Records Access - Request for Examination of Education Records
REQUEST FOR EXAMINATION OF EDUCATION RECORDS
To:_________________________________ Address:___________________________
Board Secretary (Custodian)
The undersigned desires to examine the following official education records.
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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.
_____________________________________________________
(Parent's Signature)
APPROVED: Date:_________________________
Address: ______________________
Signature:_____________________ City:__________________________
Title: _________________________ State:__________ ZIP:___________
Dated: ________________________Phone Number:_________________
Approved: October 14, 2024; October 13, 2025
Reviewed: October 14, 2024
Revised: October 14, 2024