University Student Initiatives Manual (USI)

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Effective: 7/12/1988

Revised: 11/1/2006

USI 203–08: Affidavit of Dependency for Release of Records

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Purpose

To allow a parent or guardian to request access to a student’s academic records

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Sources

Family Educational Rights and Privacy Act of 1974 (also referred to as the Buckley Amendment or FERPA), 20 United States Code §1232g (1982)

University Registrar’s Office

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Policy

A parent or guardian may request access to a dependent student’s academic records by filing an Affidavit of Dependency and a copy of the parent’s or guardian’s most recent signed IRS 1040 form with the University Registrar’s Office or Registration Services at the Polytechnic or West campus. Access is subject to the approval of the appropriate office.

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ProcedureD

Responsibility	Action
Parent or guardian	Request access.
Academic Files Section or Registration Services at the Polytechnic or West campus	Supply the instructions required and an Affidavit of Dependency.
Parent or guardian	Take affidavit to be notarized. Return the notarized affidavit with a copy of the parent or guardian’s most recent signed IRS 1040 form to the Academic Files Section of the University Registrar’s Office (SSV 140) or Registration Services at the Polytechnic or West campus.
Academic Files Section or Registration Services at the Polytechnic or West campus	Determine that the affidavit and documents are correct and complete. Release requested records if appropriate. File the affidavit for reference for two years and cross-reference it on the Student Information System.
Parent or guardian	Renew affidavit every tax year.

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Cross-Reference

See also USI 107–01, “Release of Student Information.”

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University Policy Manuals Group
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Dorothy DiRienzi, Editor/Publisher