Code No. 5O6.1E4
REQUEST FOR HEARING ON CORRECTION OF STUDENT RECORDS
To: ______________________________________Address: __________________________
Board Secretary (Custodian)
I believe certain official student records of my child,______________________
_______________________________, (Full Legal Name of Student), Riverside Community School District, are inaccurate, misleading or in violation of privacy or other 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.
___________________________________
(Signature)
Date: ____________________________
Address:___________________________
City: _____________________________
State: ____________ZIP ____________
Phone Number: _____________________