506.1E4 Request for Hearing on Correction of Student Records

Code No. 506.1E4

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: _________________________

Approved: 11/11/09

Reviewed: 2/6/22

Revised: 1/6/10

Grinnell-Newburg School District, Grinnell, IA