IGBAB/JO-AR2 - Records Request and Information Release

Adopted: 8/22/12

The district shall permit an eligible student (age 18 or older) or student's parent(s) to receive upon written request information and/or education records of the student within the guidelines of Family Educational Rights and Privacy Act (21 USC § 1232g). In that case the eligible student or student's parent(s) may inspect, review or be informed of only the specific information about the student. This written request will be permanently added to the student's education record.

I                                                                                                                             (Please print) , a

[ ] Custodial Parent   [ ] Non-custodial Parent     [ ] Eligible Student     [ ] Court Representative,
(Court ordered request)

am requesting:

[ ] release of information for review only; and/or

[ ] copies of the student records for:


                                                                   , who attends                                                                                  .
                  (Name of student)                                                              (Name of School)

Reason for requesting these records:                                                                                                                                                                             




Signature of person requesting records           Name of person releasing records (please print)
Signature of person releasing records