Penn State Office of the University Registrar

Undergraduate Nondegree Enrollment Form

Please fill out this online form, print (using "Print Form" button at bottom of last page), sign and return to the Registrar's Office at the campus where enrollment is planned.

If you are registering as an undergraduate nondegree student you must complete and return this form to the Registrar's Office at the campus where enrollment is planned. Enrollment as a nondegree student does not imply admission to the University. You must make formal application to be considered for admission as an undergraduate degree student.

SECTION 1: Biographic Information
Name:


Name:


Name:
Gender:
(mm/dd/yyyy)
Permanent Residence:
SECTION 2: Enrollment
Enrollment Request for:
Enrollment Request for:
Enrollment Request for:
Have you ever enrolled at Penn State?

Are you currently in an academic drop status from Penn State or any other college or university previously enrolled?

Have you ever been dismissed or suspended for disciplinary reasons from secondary school, Penn State, or any other institution, OR are you inelgible to return to a prior institution due to a disciplinary matter?

Is there an unresolved or pending disciplinary matter at a prior institution?

Have you ever pled guilty or no contest to, participated in a presentencing diversion program for, and/or been convicted of a criminal offense, OR are there criminal charges pending against you at this time?

Have you ever been denied admission to Penn State?
Are you planning to take courses to earn a degree?
For students enrolling at University Park Only:

I assert that I (check all that apply):

SECTION 3: Ethnic Background

Federal law requires that institutions of higher education gather the following information regarding the ethnicity and race of their students and employees. Your individual information will be kept strictly confidential. The law only requires institutions to report aggregate totals for each category.

Select the appropriate responses regarding your ethnicity and your race:

Is your ethnicity Hispanic/Latino (Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin)?
What is your race (select one or more):

*The social security number (SSN) you provide for enrollment purposes, or when requesting specific services, will be used by the University to verify your identity for official record keeping and reporting. If you choose not to supply your SSN, certain services, such as transcripts, enrollment verification, tax reporting, financial aid and other services will not be available to you, and Penn State cannot guarantee a complete academic record for you. Your SSN will be stored in a central system and only used for official reporting and record keeping. It will not be used as a primary source to identify you within the Penn State system; the PSU ID will be used as the primary identifier.

Revised 3/29/16