Text Version of this Form
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Academic Renewal Form
The Registrar’s Office at the
campus you plan to enroll.
An undergraduate student returning to the University may request the Registrar to approve Academic Renewal according
to policy 58-60. To be approved:
— The student must have had an absence of at least four-years during which they were not enrolled in any Penn
State credit courses, and
— The student’s previous cumulative grade-point average must be below 2.00.
Student Name: _______________________________________________________
PSU ID: ________________________________________ or SSN: _________________________________
Semester Last Enrolled: Spring: ____ Summer: _____ Fall: ____ Year: _________
Permanent Residence: (Confirmation letter will be sent to this address.)
Street 1: _________________________________________________
Street 2: _________________________________________________
Phone Number: _(______)___________________________________
Semester Effective: Spring: _____ Summer: _____ Fall: _____ Year: _________
If Academic Renewal is granted:
— The number of late drop credits available to the student will be reset to the number provided by policy 34-89.
— Students who did not meet the satisfactory academic progress standards for federal student aid eligibility during
their most recent prior semester of enrollment should contact the Office of Student Aid to determine if an appeal
to regain federal aid eligibility is applicable.
Student Signature: _______________________________________
______ Date: ____________________________