Adopted: June 1980
Revised: January 2013
Download 505.2.11P - Request to Amend Educational Records
REQUEST TO AMEND EDUCATIONAL RECORDS
To: District 196 Superintendent Date:
3455 153rd St. W.
Rosemount, MN 55068
From: Phone:
Parent or guardian
Re: Student School
I hereby request that certain information in my child's educational records be amended. The specific information challenged is as follows:
Description of information challenged Reason Requested amendment
(Identify specific record in question) (Accuracy, completeness, etc.)
l.
2.
3.
4.
5.
Date Signature of parent, guardian or eligible student