Fillable Minnesota State University Administrative Hearing Request

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Minnesota State University Administrative Hearing Request

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_______________________________________________________________________________________________________________________________________
Minnesota State University Moorhead is committed to the protection and confidentiality of student educational records, adhering
closely to the guidelines established by the Family Educational Rights and Privacy Act – a federal legislation established to regulate
access and maintenance of student educational records.
I r
equest a formal hearing concerning correction of what I believe to be inaccurate or misleading information, described below,
contained in my education records.
Pl
ease notify me of the date, time, and place of the hearing.
Student Name Student ID
Pho
ne Number Email
Si
gnature of Student: ____________________________________________________________ Date: _________________________
He
aring Date Hearing Time Hearing Location Student notified on (date)
Adm
inistrative Hearing Decision:
Registrar Signature: ______________________________________________________________Date: _________________________
Minnesota State Un
iversity Moorhead Registrar’s Office
Owens Hall 210 | 1104 7
th
Ave S | Moorhead MN 56563
Phone: 218.477.2565 Fax: 218.477.2941
Email: Registrar@mnstate.edu
Minnesota State University is an equal opportunity educator & employer and is a member of the Minnesota State System.
Student Request for Administrative Hearing
Regarding Student Education Records
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Minnesota State University Administrative Hearing Request

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Completed 14 April 2020

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