CORONAVIRUS UPDATES: Keep up with the latest updates from Penn State about the global coronavirus outbreak.

 

Record of Non-Credit Course Enrollment Form

Please print and return the completed form to:

Penn State Outreach Non-Credit Registration Office
P.O. Box 410
State College, PA 16804

Fax: 814-863-2765

Please print and return the completed form to:
Penn State Outreach Non-Credit Registration Office
P.O. Box 410
State College, PA 16804
Fax: 814-863-2765

Identification

Please enter your name.
9-digit Penn State ID number
Please enter your PSU ID.
*Only enter your SSN if you do not provide your PSU ID number.
Please include area code
Please enter your daytime phone number.
Please enter a valid email address.

The following information is included in a record of non-credit course enrollment:

  • Name
  • PSU ID Number
  • Date of birth (month and day)
  • List of all non-credit course(s) taken at Penn State and grades if applicable

Record of Non-Credit Course Enrollment

Please enter the number of copies needed
Please enter the campuses in which courses were taken.

Address Where Record of Non-Credit Course Enrollment is to Be Mailed

Please enter your name.
Please enter street address.
Please enter city.
Please enter zip code.

Authorization

Please enter release justification.

Please review your entries on this form. If all information is entered correctly, please print, sign, and submit the form to the address at the top.

Student Signature

Student Signature: _________________________________________________

Date: ____________________________

Student Signature: _______________________________________ Date: __________________________

Last Revised: 7/6/11