Parental Affidavit for Academic Information
FERPA requires that access to a student’s education records must be granted by approval of the student. A parent may, however be
granted access if the student is claimed as a dependent on the Internal Revenue tax forms. With a completed Parental Affidavit for
Academic Information, a parent may be allowed to view elements of their student’s education record. To be granted access, complete
and submit this form and attach a copy of the most recent year’s federal tax form documenting your student as a dependent.
*If your student is not listed as a dependent, they must complete a Release of Information (ROI) form before access to education records may be granted.
Student Name:
SID#:
In accordance with the Family Education Rights and Privacy Act (FERPA), the undersigned requests the following items to be released:
☐ Copy of student’s class schedule
☐ Copy of student’s unofficial academic transcript
☐ Copy of student’s bill and payment plan information
☐ Copy of student’s financial aid award information
Parent/Guardian Information:
Name:
☐
Mother ☐ Father ☐ Guardian
Address: City: State: Zip:
Phone Number(s):
The undersigned affirms and represents:
1.
The undersigned is a parent or guardian of the above-named student.
2.
The above-named student is a dependent student of the undersigned as such term is defined in Section 152 of the Internal
Revenue Code of 1954. The student has been claimed by the undersigned as a dependent on the federal income tax return for
the year in which this request is dated.
3.
The undersigned will furnish the College upon its request such information as the College may reasonably require to confirm that
the student is a dependent of the undersigned.
4.
The undersigned will indemnify the College from any loss which the College may incur to the student or any other person as a
result of furnishing the information requested herein.
5.
The undersigned agrees to keep the disclosed information confidential according to applicable legislation and regulations.
NOTE: The student will be notified of this request before the College will respond to this request.
I hereby certify the foregoing to be true, knowing that Columbia Basin College will rely upon the statements made by me herein in
furnishing the information which I have requested.
I understand that I must make this request for information each time I require student information.
Parent/Guardian Signature:
Date:
(Must be signed in the presence of the Registrar.)
*Copy of parents’ most recent federal tax return must accompany this completed form.
The parent/guardian must submit this form in person.
Check in at Hawk Central and the Registrar will meet with you to review your request for academic information.
Columbia Basin College complies with the spirit and letter of state and federal laws, regulations and executive orders pertaining to civil rights, Title IX, equal opportunity and affirmative action. CBC does not discriminate on the basis of race, color, creed, religion, national or ethnic origin, parental status
or families with children, marital status, sex (gender), sexual orientation, gender identity or expression, age, genetic information, honorably discharged veteran or military status, or the presence of any sensory, mental, or physical disability, or the use of a trained dog guide or service animal (allowed by
law) by a person with a disability, or any other prohibited basis in its educational programs or employment. Questions or complaints may be referred to the Vice President for Human Resources & Legal Affairs and CBC’s Title IX/EEO Coordinator at (509) 542-5548.Individuals with disabilities are
encouraged to participate in all college sponsored events and programs. If you have a disability, and require an accommodation, please contact the CBC Resource Center at (509) 542-4412 or the Washington Relay Service at 711 or 1-800-833-6384. This notice is available in alternative media byrequest.
