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503.1E4 Notification of Transfer of Student Records

To: __________________________________ Date: ________________________


Parent/Legal Guardian




City, State, Zip Code


Please be notified that we have received a written statement that a student, __________________ (full legal name of student), who previously attended ________________________ Community School District, intends to enroll in ________________________ Community School District.

Please be further notified that the official student records of a student, __________________ (full legal name of student), which were previously held by ________________________ Community School District, have been transferred to _____________________________ Community School District.

The records may now be accessed by contacting the records custodian at ________________ Community School District.

If you desire a copy of such records furnished, please check here _____, and return this form to the undersigned at ________________________ Community School District. 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.





(Printed Name)







Approved:                                              Reviewed: 5/13/13; 6/10/19                                              Revised: