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506.1E5 Request For Examination Of Student Records

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: