To: ___________________________________ __________________________________
Board Secretary (Custodian) Address
I believe certain official education records of my child,___________________________ , (full legal name of student), Winfield Mt. Union School District, 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
UPLOAD FORM