Request for Hearing on Correction of Student Records
To:_____________________________________________________________ Date:______________________________
Board Secretary, Custodian of Records
I believe certain student records of student,_________________________________ , (full legal name of student), a student at Interstate 35 Community School District to be inaccurate, misleading, or in violation of the student’s rights under state and federal law.
The student records which I believe are inaccurate, misleading or in violation of the student’s rights under state and federal law are:
_________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
The reason(s) I believe these student records are to be inaccurate, misleading or in violation of the student’s rights under state and federal law are:
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
I have the following relationship to the student:__________________________________________________________________________
I understand that I will be notified in writing of the time and place of the hearing; that I will be notified in writing of the decision; and I have the right to appeal the decision by so notifying the hearing officer in writing within ten (10) days after my receipt of the decision or a right to place a statement in my child's record stating that I disagree with the decision and why.
____________________________________________ Signature
____________________________________________ Date
____________________________________________ Address
____________________________________________ City
____________________________________________ State, Zip
____________________________________________ (Phone Number)
Revised/Reviewed: April 22, 2024