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: _________|