Attachment II

Affidavit

Parental Access to Student Records

Date:

Affiant Name: ______

Address: ______

________________

Affiant swears that the following statements are true:

1. I am a parent of the Texas State student listed below.

2. I am requesting a copy of the records listed below. I understand that there may be a fee charged for some documents, such as $5.00 for a transcript.

3. My child is a dependent student as defined in Section 152 of the Internal Revenue Code of 1986.

Student's Name:

Student's SSN:

Records Requested:

______

Affiant's Signature

Sworn to and subscribed before me this day of , ______.

Notary Public, State Of Texas