Return to List of Exhibits and Figures
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: |
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________________________________ ________________________________ ________________________________ ________________________________ |
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________________________________ ________________________________ ________________________________ ________________________________ |
Signature: ________________________________
Address: ________________________________
For Official Use Only
Date of Hearing Scheduled: ________________________
Location: ________________________
Date of Notification Sent: ________________________
Signature of Official Approving/Denying Request: ________________________