Home School Records Request Form
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1Home School Program • Linn Benton Lincoln Education Service District
905 4th Avenue SE • Albany, Oregon 97321-3199 • Phone: 541-812-2687 • Fax: 541-926-6047 •
H
S
R
R
F
OME
CHOOL
ECORDS
EQUEST
ORM
Date___________________________
I/We __________________________________ request copies of the following record(s) for
____________________________________,
(Student name)
(Date of birth)_____________________________________
Specific Record _____________________ dated ________________________________
All test result reports
All notification forms/letters
All status letters
All records
Other __________________________________________________________________
I/We are the parent(s) of __________________________, and have the right to inspect to inspect
his/her educational records under OAR 581-021-0270.
Signature
Date
I _________________________________ am an eligible student and have the right to inspect my own
educational records under OAR 581-021-0270.
Signature
Date
Legal Definition per OAR 581-021-0220:
“Parent” means a parent of a student and includes a natural parent, a guardian, an individual authorized in writing to act as a
parent in the absence of a parent or guardian, or a surrogate parent appointed to represent a student with disabilities.
“Eligible student" means a student who has reached 18 years of age or is attending an institution of postsecondary
education and is not enrolled in a secondary school.
Mailing Address
Phone Number
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