Penn State Office of the University Registrar

Temporary Change of Campus Request

(For ONE Semester ONLY)

Please fill out this online form, print (using "Print Form" button at bottom of page), sign and:
Return to:
Change of Campus Contact

Effective Semester:
Courses I intend to take at other campus:

I understand the following if this request is approved:

  • Valid for one semester only
  • My location will automatically change back to my current campus at the end of one semester
  • I will retain the same academic adviser while at the requested campus
  • It will be my responsibility to communicate with my adviser regarding my academic progress
  • I will be responsible for securing housing if applicable

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 appropriate change of campus contact.

Student Signature: _____________________________________ Date: ___________________

Adviser Signature: _____________________________________ Date: ___________________

Registrar Use Only

Current Campus Decision: ____ Approved ____ Denied User ID: _______ Date: _______

Requested Campus Decision: ____ Approved ____ Denied User ID: _______ Date: _______

Revised 6/15/11