Former Students: Special Ed/504 Record Request Form

Former Students: Special Ed/504 Record Request Form

This form is intended for former VASD students over the age of 18.
The rights held by a parent regarding his or her minor child transfer to the child when the child reaches the age of 18 years, 34 CFR 99.5. However, the parents of an adult student who continues to be financially dependent upon the parents may continue to have access to their child’s pupil records unless the adult student notifies the school in writing this information may not be shared with the parents without the student’s permission, Wis. Stat. sec. 118.125(2)(k).

Documentation showing a former student's "dependency" status will be required if a parent/guardian of a former student wishes to request the records on their behalf (the former student can request the records themselves as well). Court-ordered guardians of former students over 18 can request records by supplying the appropriate documentation.

Former students over 18 who are not financially dependent upon their parents or do not have a court-appointed guardian must request the records themselves. The former student must complete/submit this form and provide proof of identity. The adult student has the opportunity within the body of the form to indicate to whom they wish the records be sent.
Former student over the age of 18Parent/Guardian of a former student over the age of 18 who is financially dependent upon parents/guardianCourt appointed guardian of a former student over the age of 18
FORMER STUDENT INFORMATION
First Name*
Last Name*
Maiden Name (if applicable)
Date of Birth*

MonthDayYear
Date
Graduation Year or Withdrawal Year*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name

First NameLast Name
Relationship to Student
REQUEST INFORMATION
College/University EnrollmentMilitary EnlistmentScholarshipApplication for Federal/State AidOther
EmailFaxU.S. Mail
Send records to email address:
example@example.com
Send records to fax number:
Please enter a valid phone number.Format: (000) 000-0000.
Mail records to:

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
SUBMISSION
Upload a copy of your State/Federal issued Photo ID (driver's license, passport, valid photo ID from a university or college).

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Upload documentation that indicates the former student is still financially dependent on parent (copy of recent tax return - please black out social security numbers).

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Upload proof of guardianship documentation (court order).

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AGREEMENT STATEMENT

I hereby affirm that I have provided complete and accurate information for the purpose of obtaining copies of confidential Special Education or 504 documents. I understand and agree that the information I have provided will be used solely for the purpose of accessing and providing copies of these educational records.

I am aware that access to these documents may be subject to federal and state regulations, including but not limited to the Family Educational Rights and Privacy Act (FERPA) and applicable state laws, and I will abide by all relevant laws and regulations pertaining to the privacy and security of these educational records.

By signing below, I affirm my understanding of these conditions and my commitment to maintaining the confidentiality and appropriate use of these documents.
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Former Students: Special Ed/504 Record Request Form

FORMER STUDENT INFORMATION

PARENT/GUARDIAN INFORMATION

REQUEST INFORMATION

SUBMISSION