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Code No. 506.1E4 Notification of Transfer of Student Records

Notification of Transfer of Student Records

 

To: ____________________________________________________          Date: _______________________________

           Parent/Legal Guardian

________________________________________________________ Address     ________________________________ City    ______ State

Please be notified that we have received a written statement that a student, ____________________________________ (full legal name of student), who previously attended _______________________________Community School District, intends to enroll in  _______________________________ Community School District.

Please be further notified that the official student records of a student, ___________________________________ (full legal name of student), which were previously held by _______________________________________________ Community School District, have been transferred to _________________________________________ Community School District.

The records may now be accessed by contacting the records custodian at  ___________________________________ Community School District.

If you desire a copy of such records furnished, please check here _____, and return this form to the undersigned at ____________________________ Community School District.  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.

 

__________________________________________________  (Signature)

__________________________________________________  (Printed Name)

___________________________________________________ (Title)

___________________________________________________ (Agency)

 

Revised/Reviewed:   April 22, 2024