REQUEST FOR HEARING ON CORRECTION OF STUDENT RECORDS
To:
Board Secretary (Custodian)
Address:____________________________________________________________
I believe certain official student records of my child,____________________________________
are inaccurate, misleading, or in violation of the privacy or other 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 10 days after my receipt of the decision.
Date:
Signature
Address: _______________________________________________
City: ____________________________________ State: _____ Zip:
Phone Number: