Penn State Office of the University Registrar

Undergraduate Retroactive Registration Form

Please fill out this online form, print (using "Print Form" button at bottom of page), sign, and
return the form with documentation to the Registrar's Office at the campus
where your courses were scheduled.


At University Park, return to:
Administrative Services, 114 Shields Building, University Park, PA 16802. Fax: 814-863-1929

Address:
Academic Information:
Semester/Session Selection:

I have read and understand the process and conditions for applying for retroactive registration.

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 return the form with documentation to the Registrar's Office at the campus where your courses were scheduled.

Student Signature: _____________________________________ Date: ___________________


College/Campus Contact and Support:

Name: _____________________________________ Title: _______________________________

Address: ___________________________________________________

Email: _________________________ Phone Number:_______________________

____ Support ____ Do Not Support ____ Letter Provided

Signature: _____________________________________

For Administrative Use Only

  • ____ Letter (student)
  • ____ Letter (college, campus or adviser)
  • ____ Schedule
  • ____ Credits
  • ____ Holds
  • ____ Grade Forms Included
  • Date Received _________________
  • Date Reviewed _________________
  • ____ Approved
  • ____ Denied; Reason:__________________________
  • Date decision letter was mailed _________________
  • Current Semester Bill Paid ____ Yes ____ No

Revised 3/22/11