The undersigned hereby requests permission to examine the __________________________________________Community School District's official
education records of:

(Legal Name of Student) ________________________________________________________________ (Date of Birth)_______________________

 

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The undersigned requests copies of the following official education 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 or U.S. Attorney General □
(d) A state or local official to whom such is specifically allowed to be reported or disclosed. □
(e) A person connected with the student's application for, or receipt of, financial aid (SPECIFY DETAILS ABOVE.) □
(f) Otherwise authorized by law. (SPECIFY DETAILS: __________________). □
[(g) A representative of a juvenile justice agency with which the school district has an interagency agreement.] □

The undersigned agrees that the information obtained will only be redisclosed consistent with state or federal law without the written
permission of the parents of the student, or the student if the student is of majority age.

                                                                                    (Signature) ______________________________________________________
                                                                                    (Title) ___________________________________________________________
                                                                                    (Agency) ________________________________________________________
                                                                                    Date: ___________________________________________________________
                                                                                    Address: ________________________________________________________
                                                                                    City: ____________________________________________________________
                                                                                    State: ___________________________________________________________
                                                                                    ZIP: ____________________________________________________________
                                                                                    Phone Number: __________________________________________________

 

APPROVED:

     Signature: _____________________________________
     Title: _________________________________________
     Dated: ________________________________________

 

The undersigned hereby authorizes ________________________________ School District to release copies of the following official education records:

_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________

concerning ____________________________________ (Full Legal Name of Student) ___________________________ (Date of BIrth).

 

(Name of Last School Attended) _____________________________________________________ (Year(s) of Attendance) from 20__ to 20__.

The reason for this request is:

_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________

 

My relationship to the child is:

_______________________________________________________________________________________________________________________

 

Copies of the records to be released are to be furnished to:

     (  ) the undersigned

     (  ) the student

     (  ) other (please specify) ________________________________________

 

                                                                            (Signature) ____________________________________________

                                                                                                        Date:  ________________________________________________

                                                                                                        Address:  _____________________________________________

                                                                                                        City:  ________________________________________________

                                                                                                        State: ______________________ Zip: ______________________

                                                                                                        Phone Number: ________________________________________

 

To: Board Secretary (Custodian) _____________________________________________
Address: ________________________________________________________________

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: ____________________________________________________________
                                                                                    State: ___________________________________________________________
                                                                                    ZIP: ____________________________________________________________
                                                                                    Phone Number: __________________________________________________

 

To: Board Secretary (Custodian) __________________________________________________________
Address: _____________________________________________________________________________

The undersigned desires to examine the following official education records.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

(Full Legal Name of Student) _____________________________________________ (Date of Birth) _______________ (Grade) _________
(Name of School) ______________________________________________________________________

My relationship to the child is: ________________________________________

(check one)
_____ I do
_____ I do not

desire a copy of such records. I understand that a reasonable charge may be made for the copies.
 

                                                                          (Signature) ______________________________________________________
                                                                          (Title) __________________________________________________________
                                                                          (Agency) _______________________________________________________
                                                                          Date: __________________________________________________________
                                                                          Address: ________________________________________________________
                                                                          City: ___________________________________________________________
                                                                          State: __________________________________________________________
                                                                          ZIP: ___________________________________________________________
                                                                          Phone Number: __________________________________________________

APPROVED:

Signature:  _______________________________
Title:  ___________________________________
Dated:  __________________________________

 

To: __________________________________________________ Date: ___________________________
Address: ______________________________________________________________________________
City / State: ______________________________________________ Zip: __________________________

Please be notified that copies of the _____________________________________________________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)____________________________________________________________

 

Date

 

 

Dear     (Parent)    :

This letter is to notify you that the                                     Community School District has received a      (subpoena or court order)     requesting copies of your child's education records.  The specific records requested are                                                     .

The school district has until   (date on subpoena or court order)   to deliver the documents to   (requesting party on subpoena or court order).  If you have any questions, please do not hesitate to contact me at   (phone #)    .

Sincerely,

 

 

 

(Principal or Superintendent)

 

Statement of Purpose:  The purpose of this Agreement is to allow for the sharing of information among the School District and the Agencies prior to a student's adjudication in order to promote and collaborate to improve school safety, reduce alcohol and illegal drug use, reduce truancy, reduce in-school and out-of-school suspensions, and to support alternatives to in-school and out-of-school suspensions and expulsions which provide structured and well supervised educational programs supplemented by coordinated and appropriate services designed to correct behaviors that lead to truancy, suspension, and expulsions and to support students in successfully completing their education.

Identification of Agencies:  This agreement is between [insert school district name] (hereinafter "School District") and [insert agency] (hereinafter "Agencies")   .

Statutory Authority:  This agreement implements Iowa Code § 280.25 and is consistent with 34 C.F.R. 99.38 (2012).

Parameters of Information Exchange:

        1.       The School District may share any information with the Agencies contained in a student's permanent record which is directly related to the juvenile justice system's ability to effectively serve the student.

        2.       Prior to adjudication information contained in the permanent record may be disclosed by the school district to the Agencies without parental consent or court order.

        3.       Information contained in a student's permanent record may be disclosed by the School District to the Agencies after adjudication only with parental consent or a court order.

        4.       Information shared pursuant to the agreement is used solely for determining the programs and services appropriate to the needs of the student or student's family or coordinating the delivery of programs and services to the student or student's family.

        5.       Information shared under the agreement is not admissible in any court proceedings which take place prior to a disposition hearing, unless written consent is obtained from a student's parent, guardian, or legal or actual custodian.

6.        Information obtained by the school from other juvenile justice agencies may not be used as the basis for disciplinary action of the student.

        7.       This agreement only governs a school district's ability to share information and the purposes for which that information can be used.  Other agencies are bound by their own respective confidentiality policies.

Records' Transmission:  The individual requesting the information should contact the principal of the building in which the student is currently enrolled or was enrolled.  The principal will forward the records within a reasonable time following receipt of the request.

Confidentiality:  Confidential information shared between the Agencies and the school district will remain confidential and will not be shared with any other person, unless otherwise provided by law.  Information shared under the agreement is not admissible in any court proceedings which take place prior to a disposition hearing, unless written consent is obtained from a student's parent.  Agencies or individuals violating the terms of this agreement subject their entity represented and themselves personally to legal action pursuant to federal and state law. 

Amendments:  This agreement constitutes the entire agreement among the agencies with respect to information sharing.  Agencies may be added to this agreement at the discretion of the school district.

Term:  This agreement is effective from [insert date].

Termination:  The School District may discontinue information sharing with an Agency if the School District determines that the Agency has violated the intent or letter of this Agreement.

 

APPROVED:
Signature: _______________________________________ Address: _______________________________________
Title: ___________________________________________ City: ___________________________________________
Agency: ________________________________________ State / Zip: ______________________________________
Dated: _________________________________________ Phone Number: __________________________________

Signature: _______________________________________ Address: _______________________________________
Title: ___________________________________________ City: ___________________________________________
Agency: ________________________________________ State / Zip: ______________________________________
Dated: _________________________________________ Phone Number: __________________________________

Signature: _______________________________________ Address: _______________________________________
Title: ___________________________________________ City: ___________________________________________
Agency: ________________________________________ State / Zip: ______________________________________
Dated: _________________________________________ Phone Number: __________________________________

Signature: _______________________________________ Address: _______________________________________
Title: ___________________________________________ City: ___________________________________________
Agency: ________________________________________ State / Zip: ______________________________________
Dated: _________________________________________ Phone Number: __________________________________

 

The Family Educational Rights and Privacy Act (FERPA) affords parents and students over 18 years of age ("eligible students") certain rights with respect to the student's education records.  They are:

(1)     The right to inspect and review the student's education records within 45 days of the day the district receives a request for access.

Parents or eligible students should submit to the school principal (or appropriate school official) a written request that identifies the record(s) they wish to inspect.  The principal (or appropriate school official) will make arrangements for access and notify the parent or eligible student of the time and place where the records may be inspected.

(2)     The right to request the amendment of the student's education records that the parent or eligible student believes are inaccurate or misleading or in violation of the student's privacy rights under FERPA.

Parents or eligible students who wish to ask school district to amend a record should write the school principal, clearly identify the part of the record they want changed, and specify why it should be changed.

If the district decides not to amend the record as requested by the parent or eligible student, the district will notify the parent or eligible student of the decision and advise them of their right to a hearing regarding the request for amendment.  Additional information regarding the hearing procedures will be provided to the parent or eligible student when notified of the right to a hearing.

(3)     The right to consent to disclosures of personally identifiable information contained in the student's education records, except to the extent that FERPA authorizes disclosure without consent.

One exception, which permits disclosure without consent is disclosure to school officials with legitimate educational interests.  A school official is a person employed by the district as an administrator, supervisor, instructor, or support staff member (including health or medical staff and law enforcement unit personnel); a person serving on the school board.  A school official also may include a volunteer or contractor outside of the school who performs an institutional service of function for which the school would otherwise use its own employees and who is under the direct control of the school with respect to the use and maintenance of PII from education records, such as an attorney, auditor, medical consultant, or therapist, a or a parent or student serving on an official committee, such as a disciplinary or grievance committee or student assistance team, or assisting another school official in performing his or her tasks.

A school official has a legitimate educational interest if the official needs to review an education record in order to fulfill his or her professional responsibility.

(4)     The right to file a complaint with the U.S. Department of Education concerning alleged failures by the district to comply with the requirements of FERPA.  The name and address of the office that administers FERPA is:

Family Policy Compliance Office, U.S. Department of Education,

400 Maryland Ave., SW, Washington, DC, 20202-4605.

 

Parents and eligible students will have a right to access a student's education records upon request without unnecessary delay and in no instance more than forty-five calendar days after the request is made. The intent of this regulation is to establish procedures for granting requests from eligible students and parents to access a student’s education records. 

Education records mean those records that contain information directly related to a student and which are maintained by an education agency or institution or by a party acting for the agency or institution. These may include, but are not necessarily limited to: dates of attendance; academic work completed; level of achievement (grades, standardized test scores); attendance data; scores on standardized intelligence, aptitude, and psychological tests; interest inventory results; health data; family background information; teacher or counselor ratings and observations; and verified reports of serious or recurrent behavior patterns.

1. Access to Records

1. Parents, eligible students, and other individuals authorized in accordance with law will have access to the student's education records during the regular business hours of the school district. Parents and eligible students will have a right to access the student's education records upon request without unnecessary delay and in no instance more than forty-five calendar days after the request is made. An eligible student or parent, upon written request to the board secretary, shall receive an explanation and interpretation of the education records. A student, eighteen years or older, has the right to determine who, outside the school system, has access to the records.  Parents of students who are 18 years or older but still dependents for income tax purposes may access the student's records without prior permission of the student.
2. School officials having access to student records are defined as having a legitimate educational interest. A school official is a person employed by the school district as an administrator, supervisor, instructor or support staff member (including health or medical staff and law enforcement unit personnel); a person serving on the school board; a person or company with whom the school district has contracted to perform a special task (such as an attorney, auditor, AEA employee, medical consultant, or therapist); or a parent or student serving on an official committee, such as disciplinary or grievance committee or student assistance team, or assisting another school official in performing his or her tasks. 

B.   Release of Information Outside the School – Information from education records may be disclosed to outside parties as outlined in board policy and otherwise provided by law.

C.  Procedures for Requesting a Record Amendment

1. If the eligible student, parent, or legal guardian believe the information in the education records is inaccurate, misleading, or violates the privacy of the student, the parents or an eligible student may request that the school district amend the education student records. 
2. The school district will decide whether to amend the education student records within a reasonable time after receipt of the request.
3. If the school district determines an amendment is made to the education student record, the school district will make the amendment and inform the parents or the eligible student of the decision in writing.
4. If the school district determines that amendment of the student's education record is not appropriate, it will inform the parents or the eligible student of their right to a hearing before the hearing officer provided by the school district. The hearing officer may be an employee of the school district, so long as the employee does not have a direct interest in the outcome of the hearing.
5. Upon parental request, the school district will hold a hearing regarding the content of a student’s education records which the parent believes to be inaccurate, misleading, or in violation of the privacy rights of students.
6. The hearing will be held within a reasonable time after receipt of the parent or eligible student’s request. The parent or eligible student will receive reasonable advance notice of date, time and place of the hearing.
7. The parents or eligible student will be given a full and fair opportunity to present evidence relevant to the issues. The parent or eligible student may be represented by an individual at their choice at their own expense.
8. The hearing officer will render a written decision within a reasonable period after the hearing.  The decision will be based upon evidence presented at the hearing and must include a summary of the evidence and the reasons for the decision.
9. The parents may appeal the hearing officer’s decision to the superintendent within 5-10 days if the superintendent does not have a direct interest in the outcome of the hearing.
10. The parents may appeal the superintendent’s decision or the hearing officer’s decision if the superintendent was unable to hear the appeal, to the board within 5-10 days.  It is within the discretion of the board to hear the appeal.
11. If the parents' and the eligible student's request to amend the education student record is further denied following the hearing, the parents or the eligible student are informed that they have a right to place an explanatory letter in the education student record commenting on the school district's decision or setting forth the reasoning for disagreeing with the school district. Additions to the student's education records will become a part of the education student record and be maintained like other education student records. If the school district discloses the education student records, the explanation by the parents will also be disclosed or the eligible student of the decision in writing.