Free PennState Academic Verification Form - PDF Form Download

Download and submit this form to the Campus for your Academic Verification.

PennState Academic Verification Form

Text Version of this Fom

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Academic Verification Form
Return To:
Verification Department
112 Shields Building
University Park, PA 16802-1271
Fax: 814-863-1929

Student Name: ___________________________________________________________

PSU ID: ___________________________ or
SSN: _______________________________

The following information will be verified:
Name Current enrolled degree(s)
Enrollment status Expected date of graduation
Date(s) of attendance-past, current, future Date of birth (month and day)
Major(s) Permanent residence and local address
Degree(s) conferred Good standing statement

Note: The academic verification reports all completed or in progress degree programs. Other academic program notations including minors, options, certificates
and non-credit programs are reported on the student’s official academic transcript.

Verification: Payment for Special Service :

_______ Number of Verifications ____ Check* (Enclosed, Payable to The Pennsylvania State University)

____ Credit Card (Visa, MasterCard, Discover or American Express)

Special Service: (Noon Cutoff Eastern Time)
__________________________
Credit Card Number:
______________________________
_______ $30 Federal Express Delivery Expiration Date:
(FedEx requires a signature upon delivery) Daytime Phone Number: ______-_______-_________

E-mail Address: ______________________________

Address where academic verification is to be mailed:

___________________________________________________
Name:
__________________________________________________
Street 1:

__________________________________________________
Street 2:

City/State/Zip: ______________________________________________

______________________________________________________________________________________

Requestor Name: ____________________________________________

Requestor Signature: _______________________________________ Date: ___________________

Note: We do not include PSU ID or social security number on the verification .

*Returned checks due to insufficient funds will result in a service charge of $25.00.

Revised: 1/21/13