558E4 - Request for Examination of Education Records

STUDENT PERSONNEL

 

Series 500

 

Policy Title:             Request for Examination of Education Records           

Code No.:             558E4

 

 

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

 

 

Carroll Community School District,

 

My relationship to the student if (applicable) 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/Eligible Student's Signature: 

 

_______________________________________________________

 

Date:  __________________________________________________________________

 

Address:  ________________________        City:_______________________________

 

State: _____________  Zip:  ________________  Phone Number:  _________________

 

 

 

 

 

APPROVED:

 

Signature:  _________________________________

 

Title:   ____________________________________

 

Dated:  ____________________________________

 

 

Date of Adoption/Review/Revision:

June 2017

December 2023