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
———————– Page 1———————–
Academic Verification Form
Return To:
Verification Department
112 Shields Building
University Park, PA 16802-1271
Fax: 814-863-1929Student 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 statementNote: 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