Records Request Form 860-695-8641

Name of Person Making Request*

First Last

Affiliation*

Organization

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Email*

Release Location / Receiver*

Student Information*

First Name Last Name Grade Level (NUMERICAL VALUE) Student ID

Date of Birth*

MM

DD

YYYY

Year of Graduation*

Last Year of Attendance*

Student's Current School

Student's Graduating School

Type of Record(s) Requested*

Select all that apply.

Other

Please specify the record requested.

Additional Information / Notes

File

According to Board policy, for the records of regular education students, the board will make records available for inspection and review by parents or eligible students within a reasonable period of time, but in any event, no more than 45 days from receipt of a written request (via website request). According to Board policy for the records of special education students, the following time frames apply: As required by Section 10-76d-1 8(b)(l) of the Regulations of Connecticut State Agencies, written requests by parents of students requiring special education and related services will be accommodated within ten (10) school days of the receipt of such requests, within three (3) school days of the receipt of such requests if the requests are made in order to prepare for a meeting regarding an individualized education program or within three (3) calendar days of such a request if the request is made in order to prepare for a meeting related to any due process proceeding. One free copy of a student’s record will be provided to parents of students requiring special education and related services via written/ web request within 5 school days of the request.

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