Code No. 506.1E6
NOTIFICATION OF TRANSFER OF STUDENT RECORDS
To: _______________________________________________________ Date: ____________
Parent/or Guardian
Street Address: __________________________________________________________
City/State ______________________________________________ ZIP _____________
Please be notified that copies of the Grinnell-Newburg Community School District's official
student records concerning _____________________, (full legal name of student) have been transferred to:
__________________________________________ _______________________________
School District Name Address
upon the written statement that the student intends to enroll in said school system.
If you desire a copy of such records furnished, please check here _____ and return this form to the undersigned. A reasonable charge will be made for the copies.
If you believe such records transferred are inaccurate, misleading or otherwise in violation of the privacy or other rights of the student, you have the right to a hearing to challenge the contents of such records.
______________________________
(Name)
______________________________
(Title)
Approved: 11/11/09
Reviewed: 2/6/22
Revised: 1/6/10
Grinnell-Newburg School District, Grinnell, IA