Office of The University Registrar

Undergraduate Re-enrollment Form

Please fill out this online form, print (using "Print Form" button below), sign and return
the form to the Registrar's Office of the campus at which you plan to enroll.

A $20.00 non-refundable re-enrollment fee will be required to complete this application.

Student Name:
PSU ID:	OR SSN:

Permanent Residence: (Confirmation letter will be sent to this address.)

Street 1:
Street 2:
City/State/Zip:
Phone Number:	ex: 800-234-5678 or (800) 234-5678

Since you last enrolled at Penn State, have you attended another college or university?
No Yes
If you answered Yes, please arrange for an official transcript to: Undergraduate Admissions Office, 201 Shields Building, University Park, PA 16802

Since you last enrolled at Penn State, have you been dismissed/suspended for disciplinary reasons from any other institution?
No Yes

Since you last enrolled at Penn State, have you pled guilty or no contest, participated in a presentencing diversion program and/or been convicted of a criminal offense, or are there criminal charges pending against you at this time?
No Yes

Re-enrollment Request:

View Degree/Major Information
Semester/Year to re-enroll:
College:
Major:
Option:
Degree:
Campus Location:
Email:
I agree to allow Penn State to use this email address to communicate with me about my re-enrollment request.

Revised: 12/12/2012