Free PennState Academic Verification Form - PDF Form Download
Download and submit this form to the Campus for your Academic Verification.
Text Version of this Fom
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Academic Verification Form
112 Shields Building
University Park, PA 16802-1271
Student Name: ___________________________________________________________
PSU ID: ___________________________ or
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:
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.