Rev. 3/2012
Office of Records and Registration
126 Tillman Hall
Rock Hill, South Carolina 29733
803/323-2194 803/323-4600 (FAX)
VERIFICATION OF DEPENDENT STUDENT STATUS
With this form, Winthrop University is allowed to release information to you about
your student’s academic records. You may have access to your student’s records until
you file your next federal income tax return. The information request must be made in
writing at the time the information is desired. Winthrop will not assume responsibility
for notification of information without a written request from the parent or guardian. If
a copy of your student’s grades is desired, a written request must be submitted at the
end of each semester.
Student Name: ______________________________________________________________
Student ID Number: __________________________________________________________
I, _________________________________________, as parent or guardian of the student
named above, verify that I claimed him/her as a dependent on my federal income tax
return for the tax year ending ______________. I am providing a copy of the tax return
as proof of dependent status. (Student dependency is defined in section 152 of the
Internal Revenue Code.)
_______________________________________ __________________________________
Signature Date
