Denial of Access To School District Records Form


Name of Requester: _____________________________________________________________.


Date of School Record Request: ___________________________________________________.


Name of Administrator Denying Record Request: _____________________________________.


Description of Records Requested (Actual written request for record may be attached):                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        


Please be advised that the school district has determined that there is a legal basis for a denial of access or copies to all or a portion of the school record requested, and hereby provides the following information in regarding such denial:


A.        Description of the contents of the records withheld:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         


B.         Statement of the specific reasons for the denial (Correlate specific portions of the records to specific reasons; include citation of statute expressly providing that particular information or records shall not be made public):                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  


NOTICE: Pursuant to Neb. Rev. Stat. § 84-712.03, you may have a right of  judicial or administrative review of the denial of access to school district records set forth above, including a right to petition for a writ of mandamus, or petition the Attorney General to review the record to determine if it may be withheld from public inspection.



                                                            COLUMBUS PUBLIC SCHOOLS

Form Adopted:     9/11/00                                            Columbus, Nebraska


Amended:  _2/12/07