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506.1E3 (KCSD 520.6) Request for Hearing on Correction of Student Records

To: __________________________________                    Date: ________________________

      Board Secretary, Custodian of Records

      Knoxville Community School District

  

 

I, the undersigned, believe certain student records of a student, _______________________ (full legal name of student), a student at _________________________ Community School District to be inaccurate, misleading or in violation of the student’s rights under state and federal law.

 

The student records which I believe are inaccurate, misleading or in violation of the student’s rights under state and federal law are:

____________________________________________________________________________________

 

____________________________________________________________________________________

 

The reason(s) I believe these student records to be inaccurate, misleading or in violation of the student’s rights under state and federal law are:

____________________________________________________________________________________

 

____________________________________________________________________________________

 

I have the following relationship to the student: ____________________________________________

 

 

______________________________________          ______________________________________  

                    (Signature)            (Printed name)

 

 

_______________________                          _________________________________________________    

                                         (Date)              ( address, city/state/zip)   

 

   

 

_______________________          ______________________________________

(Phone)              (Email address )       

 

 

 

Approved:  7/15/2019                               Reviewed:                     Revised: