Code No. 506.1E2 Student Request Form for Non-Parents

Student Record Request Form for Non-Parents

The undersigned hereby requests permission to examine the Interstate 35 Community School District's official student records of:

__________________________________________                           ________________________________ 

Legal Name of Student                                                                                  Date of Birth

The undersigned requests copies of the following official student records of the above student:

The undersigned certifies that they are (check one):

• An 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 representative of the Secretary of the U.S. Department of Education or U.S. Attorney General.
• An administrative head of an education agency as defined in Section 408 of the Education Amendments of 1974.
• An official of the Iowa Department of Education.
• A person connected with the student's application for, or receipt of, financial aid.
• A representative of a juvenile justice agency with which Interstate 35 Schools has an interagency agreement.                                                                              

The undersigned agrees that the information obtained will only be redisclosed consistent with state or federal law without the written permission of the parents of the student, or the student if the student is of majority age.

_________________________________Signature   ____________________________Agency

_________________________________Title           ____________________________Date

_________________________________Address     __________________City  _____State

_________________________________Phone

Approved: June 29, 2015

Revised/Reviewed:  April 22, 2024