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
