Code No.: 506.1E5
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 8/17/15
Revised 6/19/17