506.01.E3 Request for Hearing on Correction of Education Records

REQUEST FOR HEARING ON CORRECTION OF EDUCATION RECORDS

To: _____________________________, Board Secretary (Custodian) for Harlan Community Schools

Address: 2102 Durant Street, Harlan, IA 51537

I believe certain official education records of my child, ___________________ (full legal name of student, school name), are inaccurate, misleading or in violation of privacy rights of my child.

The official education records which I believe are inaccurate, misleading or in violation of the privacy or other rights of my child are: ____________________________________________________________________.

The reason I believe such records are inaccurate, misleading or in violation of the privacy or other rights of my child is: ____________________________________________________________________________.

My relationship to the child is: __________________________________________________________.

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 days after my receipt of the decision or a right to place a statement in my child’s record stating I disagree with the decision and why.

Signature: _____________________________________

Date: ____________________________

Address: _____________________________________________________________

City: _______________________________ Zip: ______________________

Phone Number: _______________________________

 

 Revised/Reviewed: 5.4.2020