Office of The University Registrar

Undergraduate Reinstatement 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 $35.00 non-refundable reinstatement fee will be required to complete this application.

Student Name:
PSU ID:	OR SSN:
Last Year Enrolled:

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 be sent to the Undergraduate Admissions Office
If you have been dismissed or suspended for disciplinary reasons from another institution since you last enrolled at Penn State, you must provide a letter of explanation with this application. Failure to do so will revoke enrollment privileges at Penn State.

Reinstatement Request:

View Degree/Major Information
Semester/Year to re-enroll:
College:
Major:
Option:
Degree:
Campus Location:

Revised: 6/22/10