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: