Citizenship Change Form

Please print, sign, and return the completed form to:

Academic Records
112 Shields Building
University Park, PA 16802-1271

Fax: 814-863-1929

Please print, sign, and return the completed form to:
Academic Records
112 Shields Building
University Park, PA 16802-1271
Fax: 814-863-1929

Identification

Student Name

Please enter your name.

Date of Birth (mm/dd/yyyy)

Please enter your date of birth.

PSU ID 9-digit Penn State ID number

Please enter your PSU ID.

*SSN *Only enter your SSN if you do not provide your PSU ID number.

Day Phone Number Please include area code

Please enter your daytime phone number.

Please enter a valid email address.

Citizenship Status as it Currently Appears in Penn State's Records

What citizenship status is currently recorded in your Penn State record?

U.S. Citizen

U.S. Permanent Resident

Not U.S. Permanent Resident

New Citizenship Status

Please select your new citizenship status:

U.S. Citizen

U.S. Permanent Resident

Not U.S. Permanent Resident

Proof of Citizenship Status

In order to process a citizenship status change request, this completed form must be submitted along with one of the following documents of citizenship change, as applicable:

Permanent Resident Card

U.S. Passport

Certificate of Citizenship

Naturalization Certificate

Please review your entries on this form. If all information is entered correctly, please print, sign, and submit form to the address at the top along with the applicable documentation of your citizenship status.

Student Signature

My signature authorizes The Pennsylvania State University to update my citizenship status on my official Penn State record.

Student Signature: _________________________________________________

Date: ____________________________

Student Signature: _______________________________________ Date: __________________________

Registrar's Office Use Only

Proof Verified by: ______________________________________________

Date: ____________________________

Date Entered into LionPATH: ____________________________

Entered by: ___________________________________________________

Last Revised: 8/20/20

Office of the University Registrar
112 Shields Building
University Park PA 16802

814-865-6357
registrar@psu.edu