Student Name: ________________________________________________
Student Signature: _____________________________________________ Date of Request: ______________
*Electronic/typed signatures are not accepted for this form.*
I wish to inspect my education record located in the following office(s):
Admissions and Records
Other ________________________________
Please provide THREE options below:
Preferred Appointment Day and Time: ______________________________
Preferred Appointment Day and Time: ______________________________
Preferred Appointment Day and Time: ______________________________
If you live 50 miles away from College of the Siskiyous you can request to review your records at a local
location. Please notify us if this is the case and where you would like to review your records.
The Family Educational Rights and Privacy Act (FERPA) requires all schools to make student education records available within 45
days of a student’s request. Same date requests are not granted. Picture ID is required before the review of your education records
can commence. FERPA provides students the following rights:
to inspect and review educational records by requesting it in writing to the appropriate College official. Requests can take up to 45
days. Students should submit to the Office of the Registrar, Program Director, department director, or other appropriate official, a
written request that identifies the record(s) they wish to inspect. The College official will make arrangements for access and notify
the student of the time and place where the records may be inspected. If the records are not maintained by the College official to
whom the request was submitted, that official shall advise the student of the correct official to whom the request should be
to request the amendment of their educational records they believe are inaccurate or misleading. Students may ask the College to
amend a record they believe is inaccurate. The student should write the College official responsible for the record, clearly identify
the part of the record they want changed, and specify why it is inaccurate. If the College decides not to amend the record as
requested by the student, the College will notify the student of the decision and advise the student of his or her right to a hearing
regarding the request for amendment. Additional information regarding the hearing procedures will be provided to the student
when notified of the right to a hearing;
may not inspect and review the following as outlined by the Act:
financial records of the parents or any information contained therein;
materials to which the student has waived his right of inspection and review including confidential letters and recommendations
associated with admission, employment or job placement; or
education records containing information about more than one student, in which case the College will permit access only to that
part of the record which pertains to the inquiring student.
Request must be submitted to the Registrar
Mail: 800 College Ave, Weed CA 96094 * Fax: (530) 938-5367 * Email: registrar@siskiyous.edu
Review Date: ___________________________ Materials Reviewed: ______________________________
Review Supervised By: ________________________ Title:_______________
Admissions and Records
Request to Review Education Records