Penn State Office of the University Registrar

Request to Release Directory Information

Please fill out this online form, print (using "Print Form" button at bottom of page), sign and:
Return to:
Registrar's Office
112 Shields Building
University Park, PA 16802

I hereby request the Registrar's office to release my previous Request to Withhold Directory Information that I filed.

  1. Name
  2. Address (local, permanent residence and electronic mail)
  3. Telephone number
  4. Class level (semester class or level: first-year, sophomore, junior, senior, etc.)
  5. Major
  6. Student activities
  7. Weight/height (athletic teams)
  8. Dates of attendance
  9. Enrollment status (full-time, part-time, or not enrolled)
  10. Date of graduation
  11. Degrees and awards received and where received
  12. Most recent educational institution attended

To process this request you must present this form along with photo identification to any campus Registrar's office or mail this form along with a copy of photo identification to the address listed above.

I have read this form carefully and understand the consequences of my decision to release my directory information. I understand:

Please review your entries on this form. If all of the information is entered correctly, please print (using "Print Form" button at bottom), sign and submit the form to the address at the top.

Signature: _____________________________________ Date: ___________________

Office Use Only

Received By: _____________________________________ Date Received: ___________________

Revised 3/1/11