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Code No. 506.1E1 Student Record Request Form for Students and Parents

Student Record Request Form for Students and Parents

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

_________________________________________            ______________________________

(Legal Name of Student)                                                     (Date of Birth)

The undersigned requests to examine and/or receive copies of the following official student records of the above student:

The undersigned requests to examine and/or receive copies of the following official student records of the above student:

___________________________________________________________________________                     

___________________________________________________________________________

The undersigned certifies that they are the parent and/or legal guardian or of the above student or that they are the above student.

The undersigned (check one):

(  )  does want copies of the above-stated student records.  I understand that the school district may charge me a reasonable fee for copies.

(  )  does not want copies of the above-stated student records.

_________________________________ (Signature)

_________________________________ (Printed Name)

_________________________________(Date)

_________________________________(Address)

_________________________________(City)

_________________________________(State, Zip)

_________________________________(Phone)

 

Approved:

__________________________________(Signature)

__________________________________(Title)

__________________________________(Date)