The undersigned hereby authorizes ___________________________________________________________________________
School District to release copies of the following official education 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: _______________________________
City: __________________________________
State: ____________ ZIP _______________
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
