NOTIFICATION OF TRANSFER OF STUDENT RECORDS

To: _____________________________    Date: _________________________

         Parent/or Guardian

Street Address: __________________________________________________

City/State:________________________________   ZIP: __________________

Please be notified that copies of the North Linn 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) ______________________________

Approved 9/23/11     Reviewed  8/18/2021   Revised