PARENTAL REQUEST FOR EXAMINATION OF STUDENT RECORDS
To: ________________________
Board Secretary (Custodian)
Address:
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 will be made for the copies.
Parent's Signature Date
Address: ________________________________________________
City: ___________________________________ State: _____ ZIP:
Phone Number:
APPROVED:
Signature: _____________________________________
Title: ____________________________________ Date:
Address:
Telephone Number: