Code No. 506.1E4
REQUEST FOR EXAMINATION OF EDUCATION 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: