Skip Navigation
small NCES header image
Forum Guide to Protecting the Privacy of Student Information: State and Local Education Agencies

Left ArrowReturn to List of Exhibits and Figures

Exhibit 5–5: Sample Request to Amend an Education Record

To: [Name of Designated Official]

From: [Name of Parent(s)]

I have reviewed my child’s education record and believe it contains information that is inaccurate, misleading, or in violation of my child’s rights. Please amend the record as follows:

Current Record: To be Changed to:
________________________________

________________________________

________________________________

________________________________

________________________________
________________________________

________________________________

________________________________

________________________________

________________________________

Signature: ________________________________

Address: ________________________________


For Official Use Only

Date of Hearing Scheduled: ________________________

Location: ________________________

Date of Notification Sent: ________________________

Signature of Official Approving/Denying Request: ________________________

Left ArrowReturn to List of Exhibits and Figures

Top


Would you like to help us improve our products and website by taking a short survey?

YES, I would like to take the survey

or

No Thanks

The survey consists of a few short questions and takes less than one minute to complete.
National Center for Education Statistics - http://nces.ed.gov
U.S. Department of Education