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The Office of the University Registrar will be closed for the Thanksgiving holiday break from Thursday, November 24, 2022 through Sunday, November 27, 2022. We will reopen at 8:00 a.m. (EST) on Monday, November 28, 2022.

Ethnic Background 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

Note: Students may log into LionPATH to change the ethnicity and race information the University has recorded in their academic record. Changes can be made on the Ethnicity page in the "My Information" section of the LionPATH Student Home Base. Instructions on how to navigate to the Ethnicity page can be found in Changes to Personal Information.

Students who do not have access to LionPATH may request a change to the ethnicity and race information the University has recorded in their academic record by completing and submitting the form below to the Office of the University Registrar.

Identification

9-digit Penn State ID number
Please enter your PSU ID.

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:

Ethnic Background

Is your ethnicity Hispanic/Latino (Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin)?

What is Your Race?

Please select one or more from the options below:

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.

Student Signature

Student Signature: _________________________________________________

Date: ____________________________

Student Signature: _______________________________________ Date: __________________________

Last Revised: 2/12/09