Copy to Parent Upon Request 

               _____ Parent Signature Required

**User Must Submit. Written Request*

               _____ No Parent Signature Required

               _____ Parent Notified in Advance

               _____ Parent Notified of Release

                _____ Request Made Part of Student Record

                _____ Schedule Hearing Following Decision with Parent

               _____ Subpoena or Judicial Order Lawfully Issued

                _____ Student Financial Aid Written Request

               _____ School or Staff in Same School System

                                                                            

No Written Request Necessary

              _____ Other School System Where Student Plans to Enroll

Forms:

506.1E2 United States Comptroller General

506.1E2 Dept. of Health,Education and Welfare Secretary

506.1E2National Institute of Education

506.1E2Iowa Dept. of Education Official

506.1E2Parent Inspection of Student Educational Records

5061.E3Notification of Transfer of Student Records

506.1E4Parent Authorization for School to Release Information

506.1E5Parent Request for Hearing to Challenge Record

506.1E6

*Such written request is available for inspection by the parent or student and the school official responsible for record maintenance.

**When a student has attained the age of 18 years or is attending an institution of post-secondary education, the permission or consent required of the rights accorded the parent of
the student will thereafter be required of and accorded only to the student.

 

The undersigned hereby requests permission to examine the North Mahaska Community School District's official student records of:

 

_________________________________________               ____________________________
Legal Name of Student                                                               Date of Birth

 

  The undersigned requests copies of the following official student records of the above student: 

 

 

The undersigned certifies that they are (check one):

        ___ (a)An official of another school system in which the student intends to enroll.

        ___ (b)An authorized representative of the Comptroller General of the United States.

        ___ (c)An authorized representative of the Secretary of the U.S. Department of Education or U.S. Attorney General

        ___ (d)An administrative head of an education agency as  defined in Section 408 of the Education Amendments of 1974.

        ___ (e)An official of the Iowa Department of Education.

        ___ (f)A person connected with the student's application for, or receipt of, financial aid

                                    (SPECIFY DETAILS ABOVE.)

       ___ (g)A representative of a juvenile justice agency with which the school district has an interagency agreement.

            The undersigned agrees that the information obtained will only be redisclosed consistent with state or federal law without the written permission of the parents of the
student, or the student if the student is of majority age.

 

___________________________________        ______________________________
Signature                                                                      Title

 

___________________________________        ______________________________
Agency                                                             Date Approved

 

___________________________________        ______________________________
Address                                                                        Phone Number

 

_________________________________________________________________________
City, State, Zip

 

The undersigned hereby authorizes North Mahaska School District to release copies of the following official student records concerning:

 

_________________________________________               ____________________________
Full Legal Name of Student                                                         Date of Birth

from 20          to 20        

 

 

_________________________________________                     ____________________________
Name of Last School Attended                                                Year(s) of Attendance

 

 

The reason for this request is:

 

 

My relationship to the child is:

 

 

Copies of the records to be released are to be furnished to:

            (  )  the undersigned

            (  )  the student

            (  )  other (please specify)

 

 

 

___________________________________        ______________________________
Signature                                                                      Date

 

___________________________________        ______________________________
Address                                                                        Phone Number

 

_________________________________________________________________________
City, State, Zip

 

To:

Address:

Board Secretary (Custodian)

I believe certain official student records of my child,                                                                           ,
                                                                                                   (full legal name of student)

                                                  are inaccurate, misleading or in violation of privacy rights of my child.
           (school name)

The official education records which I believe are inaccurate, misleading or in violation of the privacy or other rights of my child are:

 

 

The reason I believe such records are inaccurate, misleading or in violation of the privacy or other rights of my child is:

 

 

My relationship to the child is:

 

 

I understand that I will be notified in writing of the time and place of the hearing; that I will be notified in

writing of the decision; and I have the right to appeal the decision by so notifying the hearing officer in

writing within ten days after my receipt of the decision or a right to place a statement in my child's record

stating I disagree with the decision and why.

 

 

___________________________________        ______________________________
Signature                                                                      Date

 

___________________________________        ______________________________
Address                                                                        Phone Number

_________________________________________________________________________
City, State, Zip

 

To:

Address:

Board Secretary (Custodian)

The undersigned desires to examine the following official education records of:

 

_________________________________________               ____________________________
Full Legal Name of Student                                                         Date of Birth

 

_____________            ___________________________________________________________
Grade                           Name of School

My relationship to the student is:

Check one:

                        ____I do desire a copy of such records.

                        ____I do not desire a copy of such records. 

 

I understand that a reasonable charge may be made for the copies.

 

___________________________________        ______________________________
Parent's Signature                                                          Date

 

___________________________________        ______________________________
Address                                                                        Phone Number

 

_________________________________________________________________________
City, State, Zip

 

APPROVED:

 

___________________________________        ______________________________
Signature                                                                      Title

 

___________________________________        ______________________________
Address                                                                        Date

 

_________________________________________________________________________
City, State, Zip

 

To:

 

Date:

 

Parent/or Guardian:

 

Street Address:

 

City/State ZIP:

 

 

Please be notified that copies of the North Mahaska 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

 

 

 

Date:

 

Dear                                               :
          Parent

This letter is to notify you that the North Mahaska Community School District has received a      (subpoena or court order)     requesting copies of your child's permanent records. 
The specific records requested are                                                                                                        .

The school district has until   (date on subpoena or court order)   to deliver the documents to   (requesting party on subpoena or court order).  If you have any questions, please do
not hesitate to contact me at   (phone #)    .

 

Sincerely,

 

 

(Principal or Superintendent)

 

Statement of Purpose:  The purpose of this Agreement is to allow for the sharing of information among the School District and the Agencies prior to a student's adjudication in
order to promote and collaborate to improve school safety, reduce alcohol and illegal drug use, reduce truancy, reduce in-school and out-of-school suspensions, and to support
alternatives to in-school and out-of-school suspensions and expulsions which provide structured and well supervised educational programs supplemented by coordinated and
appropriate services designed to correct behaviors that lead to truancy, suspension, and expulsions and to support students in successfully completing their education.

Identification of Agencies:  This agreement is between the North Mahaska Community School District (hereinafter "School District") and the Mahaska County Sheriff's Office and
the New Sharon Police Department (hereinafter "Agencies").

Statutory Authority:  This agreement implements Iowa Code § 280.25 and is consistent with 34 C.F.R. 99.38 (2004).

Parameters of Information Exchange:

        1.       The School District may share any information with the Agencies contained in a student's permanent record which is directly related to the juvenile justice system's
ability to effectively serve the student.

        2.       Prior to adjudication information contained in the permanent record may be disclosed by the school district to the Agencies without parental consent or court order.

        3.       Information contained in a student's permanent record may be disclosed by the School District to the Agencies after adjudication only with parental consent or a court
order.

        4.       Information shared pursuant to the agreement is used solely for determining the programs and services appropriate to the needs of the student or student's family or
coordinating the delivery of programs and services to the student or student's family.

5.       Information shared under the agreement is not admissible in any court proceedings which take place prior to a disposition hearing, unless written consent is obtained
from a student's parent, guardian, or legal or actual custodian.

6.        Information obtained by the school from other juvenile justice agencies may not be used as the basis for disciplinary action of the student.

        7.       This agreement only governs a school district's ability to share information and the purposes for which that information can be used.  Other agencies are bound by their
own respective confidentiality policies.

Records' Transmission:  The individual requesting the information should contact the principal of the building in which the student is currently enrolled or was enrolled.  The
principal will forward the records within 10 business days of the request.

Confidentiality:  Confidential information shared between the Agencies and the school district will remain confidential and will not be shared with any other person, unless
otherwise provided by law.  Information shared under the agreement is not admissible in any court proceedings which take place prior to a disposition hearing, unless written
consent is obtained from a student's parent.  Agencies or individuals violating the terms of this agreement subject their entity represented and themselves personally to legal action
pursuant to federal and state law. 

Amendments:  This agreement constitutes the entire agreement among the agencies with respect to information sharing.  Agencies may be added to this agreement at the discretion
of the school district.

Term:  This agreement is effective from February 15, 2010.

Termination:  The School District may discontinue information sharing with an Agency if the School District determines that the Agency has violated the intent or letter of this Agreement.

 

APPROVED:

 

Signature:  ________________________________________   Title: _________________________

 

Address: _______________________________  City: ____________ State: __________ ZIP: _____

 

Agency: _________________________________________________________________________

 

Phone Number: ____________________                                                        Dated: ______________

 

 

Signature:  ________________________________________   Title: _________________________

 

Address: _______________________________  City: ____________ State: __________ ZIP: _____

 

Agency: _________________________________________________________________________

 

Phone Number: ____________________                                                        Dated: ______________

 

 

Signature:  ________________________________________   Title: _________________________

 

Address: _______________________________  City: ____________ State: __________ ZIP: _____

 

Agency: _________________________________________________________________________

 

Phone Number: ____________________                                                        Dated: ______________

 

The Family Educational Rights and Privacy Act (FERPA) affords parents and students over 18 years of age ("eligible students") certain rights with respect to the student's
education records.  They are:

(1)     The right to inspect and review the student's education records within 45 days of the day the district receives a request for access.

Parents or eligible students should submit to the school principal a written request that identifies the record(s) they wish to inspect.  The principal will make
arrangements for access and notify the parent or eligible student of the time and place where the records may be inspected.

(2)     The right to request the amendment of the student's education records that the parent or eligible student believes are inaccurate or misleading or in violation of the
|student's privacy rights.

Parents or eligible students may ask the school district to amend a record that they believe is inaccurate or misleading.  They should write the school principal,
clearly identify the part of the record they want changed, and specify why it is inaccurate or misleading.

If the district decides not to amend the record as requested by the parent or eligible student, the district will notify the parent or eligible student of the decision and
advise them of their right to a hearing regarding the request for amendment.  Additional information regarding the hearing procedures will be provided to the parent
or eligible student when notified of the right to a hearing.

(3)     The right to consent to disclosures of personally identifiable information contained in the student's education records, except to the extent that FERPA authorizes
disclosure without consent.

One exception, which permits disclosure without consent is disclosure to school officials with legitimate educational interests.  A school official is a person
employed by the district as an administrator, supervisor, instructor, or support staff member (including health or medical staff and law enforcement unit personnel); a
person serving on the school board; a person or company with whom the district has contracted to perform a special task (such as an attorney, auditor, AEA
employees, medical consultant, or therapist); or a parent or student serving on an official committee, such as a disciplinary or grievance committee or student
assistance team, or assisting another school official in performing his or her tasks.

A school official has a legitimate educational interest if the official needs to review an education record in order to fulfill his or her professional responsibility.

Upon request, the district discloses education records without consent to officials of another school district in which a student seeks or intends to enroll.

(4)    The right to inform the school district that the parent does not want directory information, as defined below, to be released.  Directory information can be released
without prior parental consent. The school district will not market or sell directory information without prior consent of the parent. 

Any student over the age of eighteen or parent not wanting this information released to the public must make object in writing by September 1 to the principal.  The
objection needs to be renewed annually. 

                Directory information includes:

                NAME, ADDRESS, TELEPHONE LISTING, DATE AND PLACE OF BIRTH, E- MAIL ADDRESS, GRADE LEVEL, ENROLLMENT STATUS, MAJOR
FIELD OF STUDY, PARTICIPATION IN OFFICIALLY RECOGNIZED ACTIVITIES AND SPORTS, WEIGHT AND HEIGHT OF MEMBERS OF ATHLETIC
TEAMS, DATES OF ATTENDANCE, DEGREES AND AWARDS RECEIVED, THE MOST RECENT PREVIOUS SCHOOL OR INSTITUTION ATTENDED BY THE
STUDENT, PHOTOGRAPH AND LIKENESS AND OTHER SIMILAR INFORMATION.

(5)     The right to file a complaint with the U.S. Department of Education concerning alleged failures by the district to comply with the requirements of FERPA.  The
name and address of the office that administers FERPA is:

Family Policy Compliance Office, U.S. Department of Education,
400 Maryland Ave., SW, Washington, DC, 20202-4605.

The School District may share any information with the Parties contained in a student's permanent record, which is directly related to the juvenile justice system's ability to
effectively serve the student.  Prior to adjudication information contained in the permanent record may be disclosed by the School District to the Parties without parental consent
or court order.  Information contained in a student's permanent record may be disclosed by the School District to the Parties after adjudication only with parental consent or a court
order.  Information shared pursuant to the agreement is used solely for determining the programs and services appropriate to the needs of the student or student's family or
coordinating the delivery of programs and services to the student or student's family.  Information shared under the agreement is not admissible in any court proceedings, which
take place prior to a disposition hearing, unless written consent is obtained from a student's parent, guardian, or legal or actual custodian.

Information obtained from others shall not be used for the basis of disciplinary action of the student.  This agreement only governs a school district's ability to share information
and the purposes for which that information can be used.

 

Student records are all official records, files, and data directly related to students, including all material incorporated into each student's cumulative record folder and intended
for school use or to be available to parties outside the school or school system specifically including, but not necessarily limited to:  dates of attendance; academic work
completed; level of achievement (grades, standardized test scores); attendance data; scores on standardized intelligence, aptitude, and psychological tests; interest inventory
results; health data; family background information; teacher or counselor ratings and observations; and verified reports of serious or recurrent behavior patterns.

The intent of this regulation is to establish procedures for granting requests from parents for access to their child's records, use of the data, and procedures
for its transmittal within forty-five calendar days.

 

A.  Access to Records

1.  The parent or legal guardian of a student will have access to these records upon written request to the board secretary.  The parent or legal guardian will, upon written request to the board secretary, have the opportunity to receive an interpretation of the records, have the right to question the data, and, if a difference of opinion is noted, is permitted to file a letter in the cumulative folder stating the dissenting person's position.  If further challenge is made to the record, the normal appeal procedures established by school policy will be followed.  A student, eighteen years or older, has the right to determine who, outside the school system, has access to the records.  Parents of students who are 18 years or older but still dependents for income tax purposes may access the student's records without prior permission of the student.

2.  School officials having access to student records are defined as having a legitimate educational interest.  A school official is a person employed by the school district as an administrator, supervisor, instructor, or support staff member (including health or medical staff and law enforcement unit personnel); a person serving on the school board; a person or company with whom the school district has contracted to perform a special task (such as an attorney, auditor, AEA employee, medical consultant, or therapist); or a parent or student serving on an official committee, such as disciplinary or grievance committee or student assistance team, or assisting another school official in performing his or her tasks.

 

B.  Release of Information Outside the School

1.  To release student records to other schools in which the student intends to enroll, the parents, legal guardian, or eligible student must be notified of the transfer and the kinds of information being released unless the school district annually notifies parents that the records will be sent automatically.

2.  Student records may be released to official education and other government agencies only if allowed by state and federal law.

3.  To release student records to other persons or agencies, written consent is given by the parent, legal guardian, or a student of majority age.  The consent form will state which records are released, to whom they are released, and the reason for the release.  A copy of the specific records being released will be made available to the person signing the release form if requested.

4.  Before furnishing student records in compliance with judicial orders or pursuant to any lawfully issued subpoena, the school district will make a reasonable attempt to notify the parent, legal guardian, or eligible student in advance.

5.  Student records may be shared with juvenile justice agencies with which the school district has an interagency agreement.  The information is shared without prior parental consent.  The agreement is a public document available for inspection.

 

C.  Hearing Procedures

1.  Upon parental request, the school district will hold a hearing regarding the content of a student's records which the parent believes to be inaccurate, misleading, or in violation of the privacy rights of students.

2.  The hearing will be held within a reasonable time after receipt of the parent or eligible student's request.  The parent or eligible student will receive reasonable advance notice of date, time, and place of hearing.

3.  The hearing officer may be an employee of the school district so long as the employee does not have a direct interest in the outcome of the hearing.

4.  The parents or eligible student will be given a full and fair opportunity to present evidence relevant to the issues.  The parent or eligible student may be represented by an individual of their choice at their own expense.

5.  The hearing officer will render a written decision within a reasonable period after the hearing.  The decision will be based upon evidence presented at the hearing and must include a summary of the evidence and the reasons for the decision.

6.  The parents may appeal the hearing officer's decision to the superintendent within 5 days if the superintendent does not have a direct interest in the outcome of the hearing.

7.  The parents may appeal the superintendent's decision, or the hearing officer's decision if the superintendent was unable to hear the appeal, to the board within 5 days.  It is within the discretion of the board to hear the appeal.