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Print Form NC A T State University Form for Disclosure to Parents of Dependent Students and Consent Form for Disclosure to Parents TO Registrar North Carolina Agricultural and Technical State University Student FIRST LAST BANNER ID MAJOR ADDRESS CITY STATE ZIP Under the Family Educational Rights and Privacy Act FERPA North Carolina Agricultural and Technical State University 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. Date Signature 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 North Carolina Agricultural and Technical State University may disclose information from your education records to your parents please sign the following consent Students cannot be denied any educational services from North Carolina Agricultural and Technical State University if they refuse to provide consent. I consent to the disclosure of any personally identifiable information from my education records to my parent s for reasons determined by North Carolina Agricultural and Technical State University as appropriate. This authorization will remain in effect for the duration of my academic studies or until I rescind the authorization in writing. If parents live at the same address please list both in 1. Parent Name s Parent Address City State Zip Phone Email. 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. 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. Date Signature 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 North Carolina Agricultural and Technical State University may disclose information from your education records to your parents please sign the following consent Students cannot be denied any educational services from North Carolina Agricultural and Technical State University if they refuse to provide consent. Date Signature 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 North Carolina Agricultural and Technical State University may disclose information from your education records to your parents please sign the following consent Students cannot be denied any educational services from North Carolina Agricultural and Technical State University if they refuse to provide consent. I consent to the disclosure of any personally identifiable information from my education records to my parent s for reasons determined by North Carolina Agricultural and Technical State University as appropriate.