FERPA Notification Parent or Guardian First Name*Parent or Guardian Last Name*Phone Number*Email Address* The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law that protects the privacy of student education records. The law applies to all programs that receive funds under an applicable program of the U.S. Department of Education. FERPA gives parents certain rights with respect to their children’s education records. At your initial visit, your provider will review these rights with you and ask you to sign that you understand the rights as presented. Below is a copy of the form that contains the information discussed at the initial visit. More detailed information on FERPA can be found at http://www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html Parental Rights Under Family Educational Rights and Privacy Act (FERPA) Under FERPA, parents have the right to: Access their child’s educational records, or receive a copy of the records, within 45 days of request. Consent to the release of the child’s records. The reason for the disclosure, record to be released and the person/party to whom the disclosure is to be made must be provided. Request that an educational record be amended. File a complaint should any of these rights be violated. I have read and understood the above policy as it relates to my child’s educational records. I also understand that I may contact my Program Coordinator with Children’s Therapy Services Early Intervention at 800-578-7906 for further information regarding this policy if needed. Child's NameCaregiver's NameDate MM slash DD slash YYYY
