The Family Policy Compliance Office is excited to announce the launch  of the new Student Privacy Website! This new website replaces both the Privacy Technical Assistance Center’s and the Family Policy Compliance Office’s sites.  The Student Privacy Website can be found at:  https://studentprivacy.ed.gov. Be sure to update your bookmarks accordingly!

Model Form for Disclosure to Parents of Dependent Students and Consent Form for Disclosure to Parents

MS Word (27 KB)

 

To:                   Registrar,  [Postsecondary Institution]

 

From:               __________________________________________________________________

Student’s First Name                          Middle Initial                          Last Name

 

                        __________________________________________________________________

                        Permanent Street Address                  City                 State                Zip Code

 

Under the Family Educational Rights and Privacy Act (FERPA), the [Postsecondary Institution] is permitted to disclose information from your education records to your parents if your parents (or one of your parents) claim you as a dependent for federal tax purposes.  Please indicate whether your parents claim you as a tax dependent. 

 

Please check the appropriate box:

  • Yes.  I certify that my parents claim me as a dependent for federal income tax purposes.
  • No.  I certify that my parents do not claim me as a dependent for federal income tax purposes.

 

Signature:        _________________________________      Date:   ______________

 

If you are not claimed as a dependent or you do not know whether you are claimed as a dependent for federal income tax purposes, but you agree that [Postsecondary Institution] may disclose information from your education records to your parents, please sign the following consent:

I consent to the disclosure of any personally identifiable information from my education records to my parent(s), for reasons determined by the [Postsecondary Institution] as appropriate.  This authorization will remain in effect for the [2008-2009] school year.*

 

Signature:        __________________________________    Date:   ________________

 

If parents live at the same address, please list both in # 1.

 

1.  __________________________________________       2.  _______________________________

            Name(s)                                                                                   Name(s)

_____________________________________________           ________________________________

            Address                                                                                   Address

_____________________________________________           ________________________________

            City, State, Zip                                                                       City, State, Zip

_____________________________________________           ________________________________

            Telephone                                                                                Telephone

 

*Students cannot be denied any educational services from the [Institution] if they refuse to provide consent.