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