NOTIFICATION OF TRANSFER OF EDUCATION RECORDS
To: _____________________________ (Parent/or Guardian)
Date: _____________________
Street Address: _______________________________________________
City/State: __________________________ Zip: _________________
Please be notified that copies of the Harlan Community School District’s official education records concerning ____________________________________________ (full legal name of student), have been transferred to: __________________________________________________ (School District Name), ______________________________________________________ (Address) upon the written statement that the student intends to enroll in said school system.
If you desire a copy of such records furnished, please check here _____ and return this form to the undersigned. 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.
Name: ______________________________
Title: _______________________________
Revised/Reviewed: 5.4.2020
