REQUEST FOR EXAMINATION OF EDUCATION RECORDS
To: Address:
Building Principal
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 child is:
(check one) I do I do not
desire a copy of such records. I understand that a reasonable charge will be made for the copies.
Signature:
Title:
Date: Phone #
Address:
City:
State: Zip:
APPROVED:
Signature:
Title:
Dated:
Date Board Adopted 10/12/1992
Date Board Reviewed 3/21/2022