Code No. 506.1E1
REQUEST OF NON-PARENT FOR EXAMINATION AND/OR COPIES OF STUDENT RECORDS
The undersigned hereby requests permission to examine the Community School District's official student records of:
,
(Full Legal Name of Student) (Date of Birth)
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The undersigned requests copies of the following official student records of the above student:
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The undersigned certifies that they are (check one):
(a) An official of another school system in which the
student intends to enroll. ( )
(b) An authorized representative of the Comptroller
General of the United States. ( )
(c) An authorized representative of the Secretary of
the U.S. Department of Education ( )
(d) An administrative head of an education agency as
defined in Section 408 of the Education Amendments
of 1974. ( )
(e) An official of the Iowa Department of Education. ( )
(f) A person connected with the student's application
for, or receipt of, financial aid (SPECIFY DETAILS
ABOVE.) ( )
The undersigned agrees that no other person will have access to any records or information obtained through this request without the written permission of the parents of the student, or the student if the student is of majority age.
(Signature)
(Title)
APPROVED: Date:
Address:
Signature: City:
Title: State: ZIP
Dated: Phone Number:
MORNING SUN COMMUNITY SCHOOL DISTRICT BOARD OF DIRECTORS