SAMPLE AFFIDAVIT FOR NON-CUSTODIAL PARENT REQUESTING by gwu46246

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									                                                                                        File:     KBBA-E-2

     SAMPLE AFFIDAVIT FOR NON-CUSTODIAL PARENT REQUESTING STUDENT
                                RECORDS

                                    (PER C.L. CII. 71, SEC. 3411)


I,     [name of non-custodial parent]                  on oath depose and state as follows:

1.     I am the parent of     [name of student]              .

2.    Attached is a certified copy of the court judgment or order relative to the custody of my child,
      which meets the standards of M.G.L. ch. 71, sec. 34H.

OR


3.     Attached is a certified copy of an order by a probate and family court judge specifically ordering
       that my child’s student records be made available to me, according to the standards of M.G.L.
       ch. 71, sec. 34H.

4.     I certify that the judgment or order remains in effect and that there is currently no temporary or
       permanent protective order restricting my access to     [name of student]           , the custodial
       parent or any child in the custodial parent’s custody.

Signed under the pains and penalties of perjury this                 ___ day of 20            .



Parent’s signature




West Springfield Public Schools

								
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