Under FERPA, a school must provide an eligible student with an opportunity to inspect and review his or her education records within
45 days following its receipt of a request.
DISABLED STUDENTS PROGRAMS & SERVICES
Request for a copy of the Student’s file
Students’ Name: _______________________________________ Student’s ID#: __________________________
E-mail address: _______________________________________ Phone #: _______________________________
I am requesting a copy of:
□ Verification of Disability
□ Accommodation form
□ Other: _____________________________________________
Student’s Signature: ____________________________________ Date: _______________________________
□ Option 1: Pick-up
I have received a copy of the file that I requested.
Student’s Signature: ____________________________________ Date: __________________________________
□ Option 2: Please send it to:
Name of Organization: __________________________________ Attention: _____________________________
Address: ______________________________________________ Phone #: _______________________________
E-mail address: ________________________________________ Fax Number: ___________________________
(if applicable) (if applicable)
Student’s Signature: ____________________________________ Date: __________________________________
FOR OFFICE USE ONLY
Documents provided: _____________________________________________________________________________
Processed by: __________________________________________ Date: _______________________________
(Staff’s Name and Signature)
