Protecting the Privacy of Student Records 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 [date]. The request was approved.

____ The record will be available at the following office for review on [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 [name] of [office] at [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 [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 [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: __________ Check No: ______ Staff initials: _____________

Date copies mailed: _________ Staff initials: ______

Amount received: ___________ 

---

 
For questions about the content of this product, please contact Lee M. Hoffman.