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Protecting the Privacy
of Student Records
Exhibit 5-5
Sample Request to Amend
an Education Record
......................................................................................................................................................
For official use only:
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: ______________________________________ Telephone number: ______________________________ |
For official use only:
| Date Received: _________ | Request approved: _________ | Denied: _________ |
| Reason(s) for denial:
_________________________________________________________________ |
| Date of hearing scheduled:_____________ | Location: _____________________________ |
| Date of notification sent: ________________
Signature of official approving/denying request: ______________________________ |
For questions about the content of this product, please contact
Lee
M. Hoffman.
