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Request to Release Directory Information

Please print, sign, and return the completed form to:

Office of the University Registrar
112 Shields Building
University Park, PA 16802

Please print, sign, and return the completed form to:
Office of the University Registrar
112 Shields Building
University Park, PA 16802

NOTE: Students with access to LionPATH should complete and submit a request to release directory information using the Change Directory Info (FERPA) form in LionPATH.

I hereby request the Office of the University Registrar to release my previous Request to Withhold Directory Information that I filed.

  1. Name
  2. Address (local, permanent residence and electronic mail)
  3. Telephone number
  4. Class level (semester class or level: first-year, sophomore, junior, senior, etc.)
  5. Major
  6. Student activities
  7. Weight/height (athletic teams)
  8. Dates of attendance
  9. Enrollment status (full-time, part-time, or not enrolled)
  10. Date of graduation
  11. Degrees and awards received and where received
  12. Most recent educational institution attended

To process this request you must present this form along with photo identification to any campus Registrar's office or mail this form along with a copy of photo identification to the address listed above.




I have read this form carefully and understand the consequences of my decision to release my directory information. I understand:

  • that all directory information listed above may be released freely.
  • that my directory information is subject to publication on the Web and printed campus directories.

Authorization

Please enter today's date.
Please enter your name.
9-digit Penn State ID number
Please enter your PSU ID.
Please enter a valid email address.
Please enter your current or previous campus.
Please enter your dates of attendance.

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: __________________________

Office Use Only

Received by: ___________________________________________________

Date Received: ____________________________

Last Revised: 3/1/11