The undersigned hereby requests permission to examine the ____________________________ Community School District's official education records of:
____________________________________________________ ____________________________________________
(Legal Name of Student) (Date of Birth)
The undersigned requests copies of the following official education 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) A state or local official to whom such is specifically allowed to be reported or disclosed. ( )
(e) A person connected with the student's application for, or receipt of, financial aid
(SPECIFY DETAILS ABOVE.) ( )
(f) Otherwise authorized by law. (SPECIFY DETAILS: __________________). ( )
(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)
APPROVED: Date: _____________________________________________
Address: __________________________________________
Signature: ___________________________________ City: _____________________________________________
Title: _______________________________________ State: __________________________ ZIP: _____________
Dated: ______________________________________ Phone Number: ____________________________________
I.C. Iowa Code Description
Iowa Code § 22 Open Records
Iowa Code § 279.9B Directors - Powers and Duties - Reports to Juvenile Authorities
Iowa Code § 280.24 Drug & Alcohol Possession Reporting
Iowa Code § 280.25 Information Sharing
Iowa Code § 622.10 Evidence - Communications in Professional Confidence
I.A.C. Iowa Administrative Code Description
281 I.A.C. 12.3 Administration
281 I.A.C. 41 Special Education
U.S.C. - United States Code Description
20 U.S.C. § 1232g Education - FERPA
20 U.S.C. §1415 IDEA - Procedural Safeguards
C.F.R. - Code of Federal Regulations Description
34 C.F.R. Pt. 300 Education - Disabilities/Children/Assistance to States
34 C.F.R. Pt. 300.610 Education - Confidentiality
34 C.F.R. Pt. 99 Education - Family Rights and Privacy
Cross References 102 Equal Educational Opportunity
102-R(1) Equal Educational Opportunity - Grievance Procedure
102-E(1) Equal Educational Opportunity - Annual Notice of Nondiscrimination
102-E(2) Equal Educational Opportunity - Continuous Notice of Nondiscrimination
102-E(3) Equal Educational Opportunity - Notice of Section 504 Student and Parental Rights
102-E(4) Equal Educational Opportunity - Discrimination Complaint Form
102-E(5) Equal Educational Opportunity - Witness Disclosure Form
102-E(6) Equal Educational Opportunity - Disposition of Complaint Form
603.03 Special Education
604.11 Appropriate Use of Online Learning Platforms
605.08 Artificial Intelligence in the Educational Environment
605.08-R(1) Artificial Intelligence in the Educational Environment - Regulation
708 Care, Maintenance and Disposal of School District Records
712 Technology and Data Security
712-R(1) Technology and Data Security - Security Requirements of Third- Party Vendors Regulation
804.06 Use of Recording Devices on School Property
804.06-R(1) Use of Recording Devices on School Property - Use of District Owned Recording Devices Regulation
901 Public Examination of School District Records
Approved: 9/20/2021, 9/16/2024, 11/17/2025
Reviewed: 10/20/2025
Revised: 10/20/2025
