506.1E5 - Notification of Transfer of Student Records

To:  ___________________________________________________________     Date:  ________________________________
          Parent/or Guardian

Street Address:  _________________________________________________________________________________________
City/State:  _____________________________________________________  ZIP:  ___________________________________

Please be notified that copies of the [insert school district name]’s official education records concerning                                        , (full legal name of student) have been transferred to:

________________________________________________________________     ____________________________________
School District Name                                                                                                    Address

upon the written statement that the student intends to enroll in said school system.

 

If you desire a copy of such records furnished, please check here            and return this form to the undersigned. A reasonable charge will be made for the copies.

 

If you believe such records transferred are inaccurate, misleading or otherwise in violation of the privacy or other rights of the student, you have the right to a hearing to challenge the contents of such records.

                                                                                                                                     _____________________________________________
                                                                                                                                      (Name)

                                                                                                                                     _____________________________________________
                                                                                                                                      (Title)