STUDENT RECORDS CHECKLIST

 

 

Request of Nonparent for Examination or Copies of Student Records

The undersigned hereby requests permission to examine the Chariton Community School District’s official student records of:

Students Legal Name: _________________________________Students Date of Birth: __________________

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

The undersigned certifies that they are (check one):

1. An official of another school system in which the student intends to enroll  ☐
2. An authorized representative of the Comptroller General of the Unites States  ☐
3. An authorized representative of the Secretary of the US Department of Education or US Attorney General  ☐
4. An administrative head of an education agency as defined in Section 408 of the Education Amendments of 1974 ☐                                
5. An official of the Iowa Department of Education ☐
6. A person connected with the student’s application for or receipt of financial aid (specify details above) ☐
7. A representative of a juvenile justice agency with which the school district has an interagency agreement ☐
8. Other State Official (specify details above) ☐

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

Signature: _______________________________________ Title: _______________ Agency: _______________

Approved: Date:                                        Address:                          

Signature:                                                        City, State, Zip:

Title:                                                  Phone Number:

Dated:          

 

AUTHORIZATION FOR RELEASE OF STUDENT RECORDS

The undersigned hereby authorizes Chariton

School District to release copies of the following official student records:

concerning

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

from 20          to 20        

(Name of Last School Attended) (Year(s) of Attend.)

The reason for this request is:

 

 

 

My relationship to the child is:

Copies of the records to be released are to be furnished to:

(  )  the undersigned

(  )  the student

(  )  other (please specify)

(Signature)

 

Date:

Address:

City:

State: ZIP

Phone Number:

 

 

 

 

REQUEST FOR HEARING ON CORRECTION OF STUDENT RECORDS

To: Address:

Board Secretary (Custodian)

 

I believe certain official student records of my child,                                               , (full legal name of student),                                      (school name), are inaccurate, misleading or in violation of privacy rights of my child.

 

The official education records which I believe are inaccurate, misleading or in violation of the privacy or other rights of my child are:

 

The reason I believe such records are inaccurate, misleading or in violation of the privacy or other rights of my child is:

 

My relationship to the child is:

 

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)

 

Date:

Address:

City:

State: ZIP

Phone Number:

 

 

 

 

REQUEST FOR EXAMINATION OF STUDENT RECORDS

To: Address:

Board Secretary (Custodian)

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 student 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 Signature)

 

APPROVED: Date:

Address:

Signature: City:

Title: State: ZIP

Dated: Phone Number:

 

NOTIFICATION OF TRANSFER OF STUDENT RECORDS

To:

 

 

 

Date:

 

 

Parent/or Guardian

 

 

 

 

 

 

 

 

 

 

 

Street Address:

 

 

 

 

 

City/State

 

 

ZIP:

 

 
 
 
 
 
 
 
 
 
 

 

Please be notified that copies of the Chariton Community School District's official student records concerning                                        , (full legal name of student) have been transferred to:

 

 

 

 

 

School District Name

 

 

Address

 

upon the written statement that the student intends to enroll in said school system.

If you desire a copy of such records furnished, please check here            and return this form to the undersigned.  A reasonable charge will be made for the copies.

If you believe such records transferred are inaccurate, misleading or otherwise in violation of the privacy or other rights of the student, you have the right to a hearing to challenge the contents of such records.

 

 

 

 

 

(Name)

 

 

 

 

 

 

 

 

(Title)

 

 

LETTER TO PARENT REGARDING RECEIPT OF A SUBPOENA

Date

Dear     (Parent)    :

This letter is to notify you that the Chariton Community School District has received a      (subpoena or court order)     requesting copies of your child's permanent records.  The specific records requested are                                                     .

The school district has until   (date on subpoena or court order)   to deliver the documents to   (requesting party on subpoena or court order).  If you have any questions, please do not hesitate to contact me at   (phone #)    .

Sincerely,

(Principal or Superintendent)

Statement of Purpose:  The purpose of this Agreement is to allow for the sharing of information among the School District and the Agencies prior to a student's adjudication in order to promote and collaborate to improve school safety, reduce alcohol and illegal drug use, reduce truancy, reduce in-school and out-of-school suspensions, and to support alternatives to in-school and out-of-school suspensions and expulsions which provide structured and well supervised educational programs supplemented by coordinated and appropriate services designed to correct behaviors that lead to truancy, suspension, and expulsions and to support students in successfully completing their education.

 

Identification of Agencies:  This agreement is between the CharitonCommunity School District (hereinafter "School District") and   (agencies listed) (hereinafter "Agencies")   .

 

Statutory Authority:  This agreement implements Iowa Code § 280.25 and is consistent with 34 C.F.R. 99.38 (1999).

 

Parameters of Information Exchange:

        1.       The School District may share any information with the Agencies contained in a student's permanent record which is directly related to the juvenile justice system's ability to effectively serve the student.

        2.       Prior to adjudication information contained in the permanent record may be disclosed by the school district to the Agencies without parental consent or court order.

        3.       Information contained in a student's permanent record may be disclosed by the School District to the Agencies after adjudication only with parental consent or a court order.

        4.       Information shared pursuant to the agreement is used solely for determining the programs and services appropriate to the needs of the student or student's family or coordinating the delivery of programs and services to the student or student's family.

        5.       Information shared under the agreement is not admissible in any court proceedings which take place prior to a disposition hearing, unless written consent is obtained from a student's parent, guardian, or legal or actual custodian.

        6.       Information obtained by the school from other juvenile justice agencies may not be used as the basis for disciplinary action of the student. 

        7.       This agreement only governs a school district's ability to share information and the purposes for which that information can be used.  Other agencies are bound by their own respective confidentiality policies.

 

Records' Transmission:  The individual requesting the information should contact the principal of the building in which the student is currently enrolled or was enrolled.  The principal will forward the records within 10 business days of the request.

 

Confidentiality:  Confidential information shared between the Agencies and the school district will remain confidential and will not be shared with any other person, unless otherwise provided by law.  Information shared under the agreement is not admissible in any court proceedings

 

which take place prior to a disposition hearing, unless written consent is obtained from a student's parent.  Agencies or individuals violating the terms of this agreement subject their entity represented and themselves personally to legal action pursuant to federal and state law. 

Amendments:  This agreement constitutes the entire agreement among the agencies with respect to information sharing.  Agencies may be added to this agreement at the discretion of the school district.

Term:  This agreement is effective from   (September 1, 2001  or other date)  .

Termination:  The School District may discontinue information sharing with an Agency if the School District determines that the Agency has violated the intent or letter of this Agreement.

APPROVED:

Signature:

 

Address:

 

 

Title:

 

City:

 

 

Agency:

 

State:

 

ZIP

 

Dated:

 

Phone Number:

 

 

 

 

 

 

 

Signature:

 

Address:

 

 

Title:

 

City:

 

 

Agency:

 

State:

 

ZIP

 

Dated:

 

Phone Number:

 

 

 

 

 

 

 

Signature:

 

Address:

 

 

Title:

 

City:

 

 

Agency:

 

State:

 

ZIP

 

Dated:

 

Phone Number:

 

 

 

 

 

 

 

Signature:

 

Address:

 

 

Title:

 

City:

 

 

Agency:

 

State:

 

ZIP

 

Dated:

 

Phone Number:

 

 

 
 
 
 
 
 
 
 
 
 
 
 
 

This agreement is optional and can only be used if the board has adopted a policy approving of its use.

 

 

 

ANNUAL NOTICE

The Family Educational Rights and Privacy Act (FERPA) affords parents and students over 18 years of age ("eligible students") certain rights with respect to the student's education records.  They are:

(1)    The right to inspect and review the student's education records within 45 days of the day the district receives a request for access.

Parents or eligible students should submit to the school principal (or appropriate school official) a written request that identifies the record(s) they wish to inspect.  The principal will make arrangements for access and notify the parent or eligible student of the time and place where the records may be inspected.

(2)    The right to request the amendment of the student's education records that the parent or eligible student believes are inaccurate or misleading or in violation of the student's privacy rights.

Parents or eligible students may ask the school district to amend a record that they believe is inaccurate or misleading.  They should write the school principal, clearly identify the part of the record they want changed, and specify why it is inaccurate or misleading.

If the district decides not to amend the record as requested by the parent or eligible student, the district will notify the parent or eligible student of the decision and advise them of their right to a hearing regarding the request for amendment.  Additional information regarding the hearing procedures will be provided to the parent or eligible student when notified of the right to a hearing.

(3)    The right to consent to disclosures of personally identifiable information contained in the student's education records, except to the extent that FERPA authorizes disclosure without consent.

One exception which permits disclosure without consent is disclosure to school officials with legitimate educational interests.  A school official is a person employed by the district as an administrator, supervisor, instructor, or support staff member (including health or medical staff and law enforcement unit personnel); a person serving on the school board; a person or company with whom the district has contracted to perform a special task (such as an attorney, auditor, AEA employees, medical consultant, or therapist); or a parent or student serving on an official committee, such as a disciplinary or grievance committee or student assistance team, or assisting another school official in performing his or her tasks.

A school official has a legitimate educational interest if the official needs to review an education record in order to fulfill his or her professional responsibility.

Upon request, the district discloses education records without consent to officials of another school district in which a student seeks or intends to enroll. 

(4)    The right to inform the school district that the parent does not want directory information, as defined below, to be released.  Any student over the age of eighteen or parent not wanting this information released to the public must make objection in writing by September 1 to the principal.  The objection needs to be renewed annually.

NAME; ADDRESS; TELEPHONE LISTING; DATE AND PLACE OF BIRTH; E-MAIL ADDRESS; GRADE LEVEL; ENROLLMENT STATUS; MAJOR FIELD OF STUDY; PARTICIPATION IN OFFICIALLY RECOGNIZED ACTIVITIES AND SPORTS; WEIGHT AND HEIGHT OF MEMBERS OF ATHLETIC TEAMS; DATES OF ATTENDANCE; DEGREES AND AWARDS RECEIVED; THE MOST RECENT PREVIOUS SCHOOL OR INSTITUTION ATTENDED BY THE STUDENT; PHOTOGRAPH AND LIKENESS AND OTHER SIMILAR INFORMATION.

(5)    The right to file a complaint with the U.S. Department of Education concerning alleged failures by the district to comply with the requirements of FERPA.  The name and address of the office that administers FERPA is:  Family Policy Compliance Office, U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC, 20202-4605.

The School District may share any information with the Parties contained in a student's permanent record which is directly related to the juvenile justice system's ability to effectively serve the student.  Prior to adjudication information contained in the permanent record may be disclosed by the school district to the Parties without parental consent or court order.  Information contained in a student's permanent record may be disclosed by the School District to the Parties after adjudication only with parental consent or a court order.  Information shared pursuant to the agreement is used solely for determining the programs and services appropriate to the needs of the student or student's family or coordinating the delivery of programs and services to the student or student's family.  Information shared under the agreement is not admissible in any court proceedings which take place prior to a disposition hearing, unless written consent is obtained from a student's parent, guardian, or legal or actual custodian.  Information obtained from others shall not be used for the basis of disciplinary action of the student.  This agreement only governs a school district's ability to share information and the purposes for which that information can be used.

The purpose for the sharing of information prior to a student's adjudication is to improve school safety, reduce alcohol and illegal drug use, reduce truancy, reduce in-school and out-of-school suspensions, and to support alternatives to in-school and out-of-school suspensions and expulsions which provide structured and well supervised educational programs supplemented by coordinated and appropriate services designed to correct behaviors that lead to truancy, suspension, and expulsions and to support students in successfully completing their education.

The party requesting the information will contact the principal of the building in which the student is currently enrolled or was enrolled.  The principal will forward the records within 10 business days of the request.

Confidential information shared between the Parties and the school district will remain confidential and will not be shared with any other person, unless otherwise provided by law.  Information shared under the agreement is not admissible in any court proceedings which take place prior to a disposition hearing, unless written consent is obtained from a student's parent, guardian, or legal or actual custodian nor can it be used as the basis for disciplinary action of the student.

 

 

USE OF STUDENT RECORDS REGULATION

Student records are all official records, files, and data directly related to students, including all material incorporated into each student's cumulative record folder and intended for school use or to be available to parties outside the school or school system specifically including, but not necessarily limited to:  dates of attendance; academic work completed; level of achievement (grades, standardized test scores); attendance data; scores on standardized intelligence, aptitude, and psychological tests; interest inventory results; health data; family background information; teacher or counselor ratings and observations; and verified reports of serious or recurrent behavior patterns.

The intent of this regulation is to establish procedures for granting requests from parents for access to their child's records, use of the data, and procedures for its transmittal within forty-five calendar days.

A.    Access to Records

        1.       The parent or legal guardian of a student will have access to these records upon written request to the board secretary.

                  The parent or legal guardian will, upon written request to the board secretary, have the opportunity to receive an interpretation of the records, have the right to question the data, and, if a difference of opinion is noted, is permitted to file a letter in the cumulative folder stating the dissenting person's position.  If further challenge is made to the record, the normal appeal procedures established by school policy will be followed.

                  A student, eighteen years or older, has the right to determine who, outside the school system, has access to the records.  Parents of students who are 18 years or older but still dependents for income tax purposes may access the student's records without prior permission of the student.

        2.       School officials having access to student records are defined as having a legitimate educational interest.  A school official is a person employed by the school district as an administrator, supervisor, instructor or support staff member (including health or medical staff and law enforcement unit personnel); a person serving on the school board; a person or company with whom the school district has contracted to perform a special task (such as an attorney, auditor, AEA employee, medical consultant, or therapist); or a parent or student serving on an official committee, such as disciplinary or grievance committee or student assistance team, or assisting another school official in performing his or her tasks. 

B.     Release of Information Outside the School

        1.       To release student records to other school(s) in which the student intends to enroll, the parents, legal guardian, or eligible student must be notified of the transfer and the kinds of information being released unless the school district annually notifies parents that the records will be sent automatically.

1. Student records may be released to official education and other government agencies only if allowed by state or federal law.

        3.       To release student records to other persons or agencies, written consent is given by the parent, legal guardian, or a student of majority age.  This consent form will state which records are released, to whom they are released, and the reason for the release.  A copy of the specific records being released will be made available to the person signing the release form if requested.

        4.       Before furnishing student records in compliance with judicial orders or pursuant to any lawfully issued subpoena, the school district will make a reasonable attempt to notify the parents, legal guardian, or eligible student are notified in advance.

        5.       Student records may be shared with juvenile justice agencies with which the school district has an interagency agreement.  This information is shared without prior parental consent.  The agreement is a public document available for inspection.

Hearing Procedures

        1.       Upon parental request, the school district will hold a hearing regarding the content of a student’s records which the parent believes to be inaccurate, misleading, or in violation of the privacy rights of students.

        2.       The hearing will be held within a reasonable time after receipt of the parent or eligible student’s request.  The parent or eligible student will receive reasonable advance notice of date, time and place of the hearing.

        3.       The hearing officer may be an employee of the school district so long as the employee does not have a direct interest in the outcome of the hearing.

        4.       The parents or eligible student will be given a full and fair opportunity to present evidence relevant to the issues.  The parent or eligible student may be represented by an individual at their choice at their own expense.

        5.       The hearing officer will render a written decision within a reasonable period after the hearing.  The decision will be based upon evidence presented at the hearing and must include a summary of the evidence and the reasons for the decision.

        6.       The parents may appeal the hearing officers decision to the superintendent within  ten days if the superintendent does not have a direct interest in the outcome of the hearing.

        7.       The parents may appeal the superintendent’s decision, or the hearing officers decision if the superintendent was unable to hear the appeal, to the board within ten days.  It is within the discretion of the board to hear the appeal.

Approved:  March 12, 2007   

Reviewed:  March 14, 2022   

Revised

The Chariton Community School District has adopted a policy designed to assure parents and students the full implementation, protection and enjoyment of their rights under the Family Educational Rights and Privacy Act of 1974.  A copy of the school district's policy is available for review in the office of the principal of all of our schools.

This law requires the school district to designate as "directory information" any personally identifiable information taken from a student's educational records prior to making such information available to the public.

The school district has designated the following information as directory information:  student's name, grade level, participation in officially recognized activities and sports; weight and height of members of athletic teams; dates of attendance; degrees and awards received, and other similar information.  You have the right to refuse the designation of any or all of the categories of personally identifiable information as directory information with respect to your student provided that you notify the school district in writing not later than August 30 of this school year.  If you desire to make such a refusal, please complete and return the slip attached to this notice.

If you have no objection to the use of student information, you do not need to take any action.

 

 

 

 

RETURN THIS FORM

 

 

 

 

 

 

 

Community School District

Parental Directions to Withhold Student/Directory Information for Education Purposes, for 20   - 20   school year.

 

 

 

 

Student Name:

 

 

Date of Birth

 

 

 

 

 

School:

 

 

Grade:

 

 

 

 

 

 

 

 

 

(Signature of Parent/Legal Guardian/Custodian of Child)

 

(Date)

 

 

 

 

 

 

 

 

This form must be returned to your child's school no later than August 30, 20        .

Additional forms are available at your child's school.

 
 
 
 
 
 
 
 
 

Approved  Mar 12, 2007   

Reviewed  February 13, 2017  

Revised

The student handbook or similar publication given to each student which contains general information about the school will contain the following statement which is published at least annually in a prominent place or in a newspaper of general circulation in the school district:

 

The following information may be released to the public in regard to any individual student of the school district as needed.  Any student over the age of eighteen or parent not wanting this information released to the public must make objection in writing by August 30, 20   to the principal.  The objection needs to be renewed annually.

 

NAME, PARTICIPATION IN OFFICIALLY RECOGNIZED ACTIVITIES AND SPORTS, WEIGHT AND HEIGHT OF MEMBERS OF ATHLETIC TEAMS, GRADE LEVEL, DEGREES AND AWARDS RECEIVED, AND OTHER SIMILAR INFORMATION.

 

                  DATED                                                                           , 20          .

 

 

Approved  Mar 12, 2007   

Reviewed  February 13, 2017

Revised