Penn State Office of the University Registrar

Reissued Minor Certificate Form

(Undergraduate Only)

Please fill out this online form, print (using "Print Form" button at bottom of page), sign and:
Return to:
Academic Records
112 Shields Building
University Park, PA 16802-1271
Fax 814-863-1929

Address where minor certificate is to be mailed:

Reissued Minor Certificate Fee: ($25 for each certificate)

x $25 = $
**Payment:

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 address at the top.

Student Signature: _____________________________________ Date: ___________________

*The requested certificate will be mailed approximately two weeks after receipt of the request.
**Any request received that does not have payment enclosed or credit card information listed, will be returned to the sender.
**Returned checks due to insufficient funds will result in a service charge of $25.00.

Revised 4/15/13