Address Correction Form

Please print and return the completed form to:

Enrollment Services
112 Shields Building
University Park, PA 16802-1271

Email: registrar@psu.edu
Fax: 814-863-1929

Please print and return the completed form to:
Enrollment Services
112 Shields Building
University Park, PA 16802-1271
Email: registrar@psu.edu
Fax: 814-863-1929

Identification

Student Name

Please enter your name.

PSU ID 9-digit Penn State ID number

Please enter your PSU ID.

Please enter a valid email address.

Permanent Residence

Street Address 1

Please enter your street address for your permanent residence.

Street Address 2

City

Please enter the city for your permanent residence.

State

Zip Code

Please enter the zip code for your permanent residence.

Country

Please enter the country for your permanent residence.

Phone Number Please include area code

Please enter the phone number for your permanent residence.

Local Address

Street Address 1

Please enter your street address for your local residence.

Street Address 2

City

Please enter the city for your local residence.

State

Zip Code

Please enter the zip code for your local residence.

Country

Phone Number Please include area code

Please enter the phone number for your local residence.

Last Revised: 4/3/19