Undergraduate Nondegree Enrollment Form

Please fill out this online form, print (using the "Print Form" button at bottom of last page), sign, and return to the Registrar's Office at the campus where enrollment is planned.

Please fill out this online form, print (using the "Print Form" button at bottom of last page), sign, and return to the Registrar's Office at the campus where enrollment is planned.

Note: Enrollment as a nondegree student does not imply admission to the University. You must make formal application to be considered for admission as an undergraduate degree student.

SECTION 1: Biographic Information

Family
Please enter your last name.
Given
Please enter your first name.
9-digit Penn State ID number
*Only enter your SSN if you do not provide your PSU ID number.
(mm/dd/yyyy)
Please enter your date of birth.
Please enter your country of birth.

Gender

Permanent Residence

Please enter your street address for your permanent residence.
Please enter the city for your permanent residence.
Please enter the zip code for your permanent residence.
Please enter the country for your permanent residence.
Please enter the length of time you have lived at your permanent residence.
Please include area code
Please enter the phone number for your permanent residence.
Please enter a valid email address.

SECTION 2: Enrollment

Enrollment Request for:

Semester

Please enter the year you would like to enroll.
Please enter the campus you would like to enroll at.

Have you ever enrolled at Penn State?


Are you currently in an academic drop status from Penn State or any other college or university previously enrolled?



Have you ever been dropped for poor scholarship from Penn State or any institution?



Have you ever been dismissed or suspended for disciplinary reasons from secondary school, Penn State or any other institution, or are you ineligible to return to a prior institution due to a disciplinary matter?



Is there an unresolved or pending disciplinary matter at a prior institution?



Within the past five years and NOT INCLUDING (1) Possession of a controlled substance, (2) Possession of paraphernalia (3) DUI/DWI/OVI/Wet Reckless, (4) Public Intoxication, and/or (5) Underage purchase, consumption, possession, or transportation, have you:

  • entered a plea of guilty or no contest to one or more criminal offenses?
  • participated in a presentencing diversion program for one or more criminal offenses?
  • been convicted of a criminal offense?
  • been incarcerated or under supervision of a probation and/or parole office?


NOT INCLUDING (1) Possession of a controlled substance, (2) Possession of paraphernalia (3) DUI/DWI/OVI/Wet Reckless, (4) Public Intoxication, and/or (5) Underage purchase, consumption, possession, or transportation, are there criminal charges pending against you at this time?



Have you ever been denied admission to Penn State?



Are you planning to take courses to earn a degree?

For Students Enrolling at University Park Only:

I assert that I (check all that apply):

SECTION 3: Ethnic Background

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:

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

What is your race (select one or more):

SECTION 4: Additional Address Information (Optional)

Local Address

Please include area code

Work Address

Please include area code

SECTION 5: Educational Background: Highest Level of Education

Please select your highest level of education (select one):

High School Information

Courses taken as an undergraduate nondegree student will appear in an undergraduate academic record. Students desiring to have course work appear on a graduate academic record must contact the Graduate School.

SECTION 6: Residency Status

Are you a U.S. Citizen?

If no, which of the following statements describes your citizenship status?

If not a U.S. Permanent Resident please enter your visa type and country of citizenship:

Are you a legal resident of the Commonwealth of Pennsylvania?

Information about Penn State's Residency Policy can be found in the University Bulletin.

SECTION 7: Signature

I have completed all applicable sections of this form and I affirm accuracy of the information provided. I understand that inaccurate information provided on this form may be cause of refusal or cancellation of my enrollment.

Student Signature: _________________________________

Date: ____________________________

Student Signature: _______________________________________ Date: __________________________


*The social security number (SSN) you provide for enrollment purposes, or when requesting specific services, will be used by the University to verify your identity for official record keeping and reporting. If you choose not to supply your SSN, certain services, such as transcripts, enrollment verification, tax reporting, financial aid and other services will not be available to you, and Penn State cannot guarantee a complete academic record for you. Your SSN will be stored in a central system and only used for official reporting and record keeping. It will not be used as a primary source to identify you within the Penn State system; the PSU ID will be used as the primary identifier.

Please review your entries on this form. If all information is entered correctly, print (using "Print Form" button below), sign and return the form to the Registrar's Office of the campus at which you plan to enroll.

Last Revised: 10/28/19