The undersigned hereby requests permission to examine and/or receive copies of the Columbus Community School District's official student records of:
(Legal Name of Student)
(Date of Birth)
The undersigned requests to examine and/or receive copies of the following official student records of the above student:
_________________________________________________________________
_________________________________________________________________
The undersigned certifies that they are the parent and/or legal guardian or of the above student or that they are the above student.
The undersigned (check one):
( ) does want copies of the above-stated student records. I understand that the district may charge me a reasonable fee for copies.
( ) does not want copies of the above-stated student records.
(Signature)
(Printed Name)
APPROVED: Date:_______________________
Address:_____________________
Signature:____________________ City:________________________
Title:_________________________ State:__________ ZIP:_________
Dates:________________________ Phone Number:_______________
Approved: 10/16/14
Reviewed: FY 2015-2016, March 14, 2016, May 24,2021
Revised: 02/24/17