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Forum Guide to Protecting the Privacy of Student Information: State and Local Education Agencies

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Exhibit 5–3: Sample Notification to Review an Education Record

Date: _______________

To:     [Name of Parent(s)]

From: [Name of Designated Official]

Your request for review of your/your child’s record was received on [insert date]. The request was approved.

______ The record will be available at the following office for review on [insert date]:

[Name and address of office, including room number and contact person]

______ As you requested, copies of the record will be mailed to you upon receipt of the copying fee: ______

Please forward your check, made payable to [appropriate agency], to [address of agency].

Please contact [insert name] of [insert office] at [insert telephone number] should you have questions regarding this notice.

Signature of Designated Official: _____________________________


For Use on Date of Review:

______ I have reviewed and/or have been informed of the contents of the requested education record on [insert date] and am satisfied with its accuracy and completeness.

______ I have reviewed and/or have been informed of the contents of the requested education record on [insert date]. I am aware that I have the right to request an amendment of all or part of the record if I am not satisfied with its accuracy and completeness. I also have received a request form for this purpose.

Signature of Parent(s): _____________________________

Signature of Staff Managing the Review: _____________________________


For Use in Copying/Mailing of Record:

Date Fee Received: _________Amount Received: _________
Check No: ________________Staff Initials: _________
Date Copies Mailed: _________Staff Initials: _________

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National Center for Education Statistics - http://nces.ed.gov
U.S. Department of Education