Code No.: 506.1E5
REQUEST FOR EXAMINATION OF EDUCATION RECORDS
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:
- I do
- I do not
desire a copy of such records. I understand that a reasonable charge may be made for the copies.
Title: State: ZIP
Dated: Phone Number: