Fillable Request to Amend Education Record Information, Instructions and (College of the Siskiyous)

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Request to Amend Education Record Information, Instructions and (College of the Siskiyous)

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Request to Amend Education Record
Information, Instructions and Forms
I. Information
Under the Family Educational Rights and Privacy Act of 1974 (FERPA), as amended, if a student
believes the education records relating to the student contain information that is inaccurate,
misleading, or otherwise in violation of the student’s privacy rights, he/ she may request to have
his/her education record amended.
If a decision is made not to amend the record as requested, the student will be informed of this
decision and of the student’s right to a hearing as required under FERPA. On request, the
student will be given an opportunity for a hearing to challenge the content of his/her education
records.
If, as a result of the hearing, a decision is made that the information is inaccurate, misleading, or
otherwise in violation of the privacy rights of the student, the record will be amended
accordingly.
If, as a result of the hearing, a decision is made that the information is not inaccurate,
misleading, or otherwise in violation of the privacy rights of the student, the student will be
permitted to place a statement in the record commenting on the contested information in the
record or stating why he or she disagrees with the decision. Such statement will be maintained
with the contested part of the record for as long as the record is maintained; and disclosed
whenever the contested part is disclosed.
II. Instructions
A student desiring to have his/her education record amended must complete and submit the
attached to the Custodian of the record(s) that the student seeks to amend.
The Custodian of such record will review the request and make a decision on the request, and
provide written notice of the decision to the student.
If a decision is made to not amend the record, the student may request a hearing to challenge
the decision by completing and submitting a request to the College’s Registrar within ten (10)
business days from receipt of the decision.
Request to Amend Education Records
Name: Student ID:
Street Address:
City: State: Zip code:
Telephone: Location of Record (Office):
I have inspected my education records maintained in the
Office/Department at the College of the Siskiyous. Under the provisions of the Family Educational Rights
and Privacy Act (FERPA), I request that these records be amended in the manner listed below:
I request that the following document(s) be removed from my file:
I believe it is in violation of my rights of privacy under FERPA as outlined below:
I have read the information on the Procedures for Requesting an Amendment of the Education Record and
for Requesting a Hearing if Request is denied.
Student Signature Date
Custodian Reviewing Request to Amend Education Record
Name: Disposition of Request:
Title: Date:
Reason for Approval/Disapproval (use next page if additional space is needed):
Custodian Signature Date
The Custodian must send a copy of this form to the student making the request and to the office of the
record location
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Request to Amend Education Record Information, Instructions and (College of the Siskiyous)

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Completed 25 July 2020

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