Parent/Guardian Verification of Student Dependent Status
The Family Educational Rights and Privacy Act (FERPA) is a Federal Law that protects the privacy of student education
records, both financial and academic. For the student’s protection, FERPA limits release of student record information
without the student’s explicit written consent; however it also gives the student’s parent(s)/guardian(s) the right to review
those records if the parent(s)/guardian(s) claim the student as a dependent on their Federal Income Tax Return.
Instructions: Please read this form carefully, complete and attach required documentation and return to the Records Office
in the Main Building, mail to 710 Colegate Drive, Marietta, Ohio 45750, or fax to 740-568-1965.
This form must be completed and returned with a signed copy of your most recent Federal Income Tax Return to certify
that the student is your dependent according to Section 152 or the Internal Revenue Code. This verification is only valid for
the current academic year through the Spring Semester. Since IRS dependency can change annually, you must submit
copies of your Federal Income Tax Return each year along with this form to continue to access the student’s records.
This release is to gain access to my dependent’s financial and/or all academic and advising records in all offices on
Washington State Community College’s campus.
I certify that I am the parent(s)/guardian(s) of (please print) ______________________________________ with
WSCC Student ID __________________ and that the student is dependent according to Section 152 of the Internal
Revenue Code.
__________________________________________ _________________________________________
Parent/Guardian Signature Parent/Guardian Signature
__________________________________________ _________________________________________
Parent/Guardian Name Please Print Parent/Guardian Name Please Print
__________________________________________ _________________________________________
Date Date
Parent/Guardian Home Address __________________________________________________________________
NOTE TO PARENTS/GUARDIANS: If your child is not a dependent as defined by IRS standards, Washington State
Community College will only be able to release information about the student’s financial and academic record if the student
completes the Family Educational Rights and Privacy Act (FERPA) Release/Revocation Form.
OFFICE USE ONLY: ______________________ _______________________________ __________________
Academic Year Processed By Date
Rev: 11/17/16
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