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Request For Records

This document is a request form for education records. It allows parents/guardians and eligible students to request access to a student's school records, as afforded by FERPA and Georgia student privacy laws. The form requests information like the student and requestor's name and contact details, the records being sought, and a signature and notarization. It notes some specific record types like academic, medical, discipline, and special education/504 records. The purpose is to allow authorized parties to access a student's education files for reasons like educational planning, medical issues, communication, or social/emotional/behavioral concerns.

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12 views

Request For Records

This document is a request form for education records. It allows parents/guardians and eligible students to request access to a student's school records, as afforded by FERPA and Georgia student privacy laws. The form requests information like the student and requestor's name and contact details, the records being sought, and a signature and notarization. It notes some specific record types like academic, medical, discipline, and special education/504 records. The purpose is to allow authorized parties to access a student's education files for reasons like educational planning, medical issues, communication, or social/emotional/behavioral concerns.

Uploaded by

cnr2ywx229
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Form JR-3

REQUEST FOR EDUCATION RECORDS


The Family Educational Rights and Privacy Act (FERPA) and the Georgia Student Data Privacy, Accessibility, and Transparency Act
afford parents/guardians and students over 18 years of age (“eligible students”) certain rights with regard to the student’s school
records including access to those records.
Name of Requesting Parent/Guardian/Eligible Student*:
Date of Request: Phone number where parent/guardian may be reached:
Student Name: Date of Birth:
Current Grade: Current School:
I hereby request that the Cobb County School District release the following education records of the student named above to me. I am
the biological parent or legal guardian of this student. My parental/guardianship rights have not been terminated and there is no court
order or agreement that states that I may not have access to information or records about my son/daughter.
REASON FOR REQUEST:
Personal Use
Release to Third Party - Name/Organization:
Address:

City: State: Zip:


The purpose of this release request to a third party is (Check All That Apply):

Educational Planning and Continuity of Care


Medical Problems Related to Learning
Ongoing communication/consultation
Social/Emotional/Behavioral Concerns
Other (specify):

SPECIFIC RECORDS NEEDED: (Check all records you are seeking):


Academic Records Special Education Records** (if applicable)
Enrollment Records 504 Records** (if applicable)
Attendance Records Gifted Records (if applicable)
Clinic Visit Records† IEL/ESOL Records (if applicable)
Discipline Records RTI/SST Records (if applicable)
Other (specify):

PLEASE NOTARIZE
Parent/Guardian/Eligible Student Name:_________________________________
(Please Print)
Sworn to and subscribed before me this
______day of ________, 20____.
Parent/Guardian/Eligible Student Signature: _____________________________
Notary Date: ______________________
Public:______________________________

** If the school receives a request for records from a party other than parents/guardians or eligible student, contact Student Support.
** If this box is checked, please send or fax (678-594-8630) this form to the Special Education/504 Records office. Special
Education/504 Records will release special education records as indicated above.
†
* If this box is checked, please contact the School Health Services office. School Health Services will provide the appropriate
records to the local school for release.

8/25/20: Student Support *JR-3* Page 1 of 1

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