Code No. 5O6.1E6
NOTIFICATION OF TRANSFER OF STUDENT RECORDS
To: ______________________________________ Date: ___________________________
Parent/or Guardian
Street Address: __________________________________________________________
City/State: _________________________________ ZIP: _______________________
Please be notified that copies of the Riverside Community School District's official student 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)