Disclosure of Student Information from Education Records
To Officials of a State Department or Agency that Operate or
Supervise Educational Programs

For Reference Purposes Only  - a printable copy of the form may be downloaded in word format

School

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Contact Person

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Fax

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Date

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Transcript Request

Student

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Date of Birth

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Last School Student Attended

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Send Student Records to:

Agency Name/ Address

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Attention

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Phone

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Fax

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Dear Registrar:

It has come to our attention that the above mentioned student previously attended your school.

To ensure that the student receives appropriate programming and benefits from previous educational experiences, we request that you forward all appropriate education records, including Educational Transcript and CSE materials, including the student's Individualized Education Program (IEP) and immunization records to the address noted above. We are requesting that a copy of the student’s transcript and last IEP be faxed to the number indicated above as soon as possible. Other records and evaluations may be faxed or mailed.

The New York State Education Department (SED) has provided clarification regarding the transfer of records. Officials from SED have indicated that according to the Family Educational 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 parent, and, upon parental request, provide the parent with a copy of the records disclosed.

Thank you for your prompt attention to this matter.