558E1 - Request of Non-parent for Examination or Copies of Education Records

STUDENT PERSONNEL

 

Series 500

 

Policy Title:             Request of Nonparent for Examination or Copies of Education Records           

Code No.:             558E1

 

The undersigned hereby requests permission to examine the Carroll Community School District's official education records of:

 

_______________________________________________________________________  (Legal Name of Student)                                     (Date of Birth)

 

 

The undersigned requests copies of the following official education records of the above student:

 

The undersigned certifies that they are (check one):

 

____            An official of another school system in which the student intends to enroll.

 

____            An authorized representative of the Comptroller General of the United States.

 

____            An authorized representative of the Secretary of the U.S. Department of                                                 Education or U.S. Attorney General.

 

____            A state or local official to whom such is specifically allowed to be reported

                        or disclosed.

 

____            A person connected with the student's application for, or receipt of, financial

                        aid (SPECIFY DETAILS ABOVE).

 

____            Otherwise authorized by law.  (SPECIFY DETAILS_____________________)

 

____            A representative of a juvenile justice agency with which the school district

                        has an interagency agreement.

 

 

The undersigned agrees that the information obtained will only be disclosed consistent with state or federal law without the written permission of the parents of the student, or the student if the student is of majority age.

 

__________________________            ___________            _____________________________

Signature                                                Title                                    Agency

 

Date: __________________    Address:  ______________________________________       

 

City:_______________________________

 

State: _____________  Zip:  ________________  Phone Number:  _________________

 

 

 

APPROVED:

 

Signature:  ______________________________________

 

Title: ___________________________________________

 

Dated:  _________________________________________

 

 

 

 

 

 

Date of Adoption/Review/Revision

June 2017

December 2023