Protecting the Privacy
of Student Records
Exhibit 6-2
Sample Request of Non-Parent
for Access to Education
Record
To: |
[Name of designated official] |
From: |
_______________________________
[Name, title, organization] |
I hereby request permission to examine the
following part(s):
of the official education records of:
_____________[name(s) of student], student(s) at:
________________________________ [name
of agency or school]. I certify that I am
(check one as appropriate):
___ An authorized official of another school
system in which the student intends to enroll.
___ An authorized representative of the Comptroller
General of the United States.
___ An authorized official of the financial
institution to which the student applied to receive financial aid. The
purpose of this request is to determine eligibility, amount of aid, conditions
of aid award, and enforcement of award terms and conditions.
___ An authorized official of an accrediting
organization. I understand that release is allowed on the conditions only
appropriate members of my organization view the records, and resulting
studies do not identify any particular student.
___ An authorized representative of the Secretary
of the U.S. Department of Education.
[Add other categories as allowed in state
or local laws and regulations.]
I agree that no unauthorized person or
organization will have access to any records or information obtained through
this request without the written permission of the parents of the student
or the student. I understand the maximum penalties for redisclosure of
the record will be [as set forth by federal and state laws and regulations].
Signature: ___________________________
Date: ____________
......................................................................................................................................................
For official use only:
Request approved/denied by: _________________________
Date:_____________
For questions about the content of this product, please contact
Lee
M. Hoffman.