City School District of Albany
Department of Special Education Services
Harriet Gibbons School
75 Watervliet Avenue
Albany, New York 12206
(518) 475-6150 FAX: (518) 475-6136
REQUEST FOR SPECIAL EDUCATION and ACADEMIC RECORDS
Date: _________________________
Student: _____________________________________ DOB: ____________ Grade: __________
It has come to our attention that the above-mentioned student is currently enrolled or is planning to
enroll in Albany City School District and has previously received special education services through your
District. At this time we are requesting any Special Education records and/or any information that is pertinent
to the student's success here in Albany City School District.
Name of Former School: ________________________________ School District: _____________________
Contact Person: _____________________________ Email address: ________________________________
Phone Number: _(______)_______________________ Fax Number: __(______)______________________
Address: _________________________________________________________________________________
Number/Street Address City State Zip Code
Signature of Parent/Guardian: _____________________________________________ Date: ___________
New York State Education (SED) has provided clarification regarding the transfer of records. Officials from SED have indicated that according to
the Family Education Rights and Privacy Act (FERPA 34 C.F.R. Part 99, as amended 4/11/98), prior consent to disclose information is not
required under certain situations. This law states, in part (§99.31 (1) (2), that "officials of other schools in school systems in which the student
may intend to enroll" may receive the student's record without a written consent for such release. Since Part 116.1(b) of NYCRR requires that
educational programs and services conducted or supervised by a State department, agency or political subdivision shall be subject to review by the
Commissioner of Education, officials of these educational programs qualify to receive student's records without written consent. Please be advised
that the educational agency or institution releasing the records is subject to the requirements of §99.34 and must make a reasonable attempt to
notify the student's parents, and upon parental request, provide the parent with a copy of the records disclosed.
Therefore, we herby request that the following Special Education and Academic Records on the above-mentioned
student as soon as possible:
All Special Education and Academic Records listed below:
Current I.E.P. (Please “transfer” IEP via IEP Direct, if you have it)
Behavioral History and Evaluations (FBA, BIP, etc.)
Most recent Psychological Testing and Social History
Educational Assessments (i.e. Woodcock Johnson Testing)
Related Services Evaluations (Counseling, Speech, OT, PT, etc.)
Most recent Physical and Immunization records
Transcripts for High School students
Level 1 Assessments (ages 12 and older)
Student transcripts, academic records, standardized test scores, report cards, cumulative health
records, attendance records, Regents scores, etc.
Other: ________________________________________________________________
Thank you for your prompt cooperation in this matter. If you have any questions, please contact me at (518) 475-6150.
Sincerely,
Catie Magil
CSE Chairperson
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