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520.6 Request for Hearing on Correction of Student Records

REQUEST FOR HEARING ON CORRECTION OF STUDENT RECORDS

 

To: __________________________________                    Date: ________________________

      Board Secretary, Custodian of Records

      __________________ Community School District

I, the undersigned, believe certain student records of a student, _______________________ (full legal name of student), a student at _________________________ Community School District to be inaccurate, misleading or in violation of the student’s rights under state and federal law.

The student records which I believe are inaccurate, misleading or in violation of the student’s rights under state and federal law are:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

 

The reason(s) I believe these student records to be inaccurate, misleading or in violation of the student’s rights under state and federal law are:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

 

I have the following relationship to the student: ____________________________________________

I understand that I will be notified in writing of the time and place of the hearing; that I will be notified in writing of the decision; and I have the right to appeal the decision by so notifying the hearing officer in writing within ten days after my receipt of the decision or a right to place a statement in my child's record stating I disagree with the decision and why.

 

 

___________________________________            ___________________________________

(Signature)                                                                  (Address)

___________________________________            ___________________________________

(Printed Name)                                                          (City, State, Zip Code)

                                                                         ___________________________________

                                                                                  (Phone Number)