Enrollment Verification Form

Please print and return the completed form to:

Verification Department
112 Shields Building
University Park, PA 16802-1271

Fax: 814-863-1929

Third-Party Verifiers should not use this request form. Please visit the National Student Clearinghouse website to make a verification request.

Please print and return the completed form to:
Verification Department
112 Shields Building
University Park, PA 16802-1271
Fax: 814-863-1929

Third-Party Verifiers should not use this request form. Please visit the National Student Clearinghouse website to make a verification request.

Identification

Student Name

Please enter your name.

Date of Birth (mm/dd/yyyy)

Please enter your date of birth.

PSU ID 9-digit Penn State ID number

Please enter your PSU ID.

*SSN *Only enter your SSN if you do not provide your PSU ID number.

Day Phone Number Please include area code

Please enter your daytime phone number.

Please enter a valid email address.

The following information will be verified: Name; Enrollment Status; Date(s) of attendance (past, current, future); Major(s); Degree(s) Conferred; Current Enrolled Degree(s); Expected Completion Date of Academic Program; Student ID.

Note: The enrollment verification reports all completed or in progress degree programs.

Number of Verifications:

*Enrollment Verifications are Available Free of Charge

Please enter the number of verifications requested.

Check if requesting verification that student never attended The Pennsylvania State University

Mailing Options

Please choose one of the following delivery methods: (Payment only required for Federal Express delivery)

U.S. Postal Service: Free Delivery

Special Service: $35 Federal Express Delivery

Payment for Federal Express Delivery

Please choose a payment method if you selected Federal Express Delivery:

Check**

Credit Card

Credit Card Number

Expiration Date

Address Where Enrollment Verification is to Be Mailed

Name

Please enter the name of the person or organization to send verification.

Street Address 1

Please enter street address.

Street Address 2

City

Please enter city.

State/Province/Region

Zip/Postal Code

Please enter zip code or postal code.

Requestor Information

Requestor Name

Please enter your name.

Please review your entries on this form. If all information is entered correctly, please print, sign, and submit the form to the address at the top.

Requestor Signature

Requestor Signature: _________________________________________________

Date: ____________________________

Requestor Signature: _______________________________________ Date: __________________________

Note: We do not include Social Security numbers on the verification.
**Returned checks due to insufficient funds will result in a service charge of $25.00.

Last Revised: 8/28/23