PROVISIONAL REENTRY REQUEST
Print form and send to Penn State Behrend, Admissions Office, 4701College Drive, Erie, PA 16563.
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Name_____________________________
Address___________________________
Provisional Admission Requested for _____________(Semester/Year) Campus Requested: Behrend Last Attended as Provisional Student ________________(Semester/Year) Campus Previously Attended _____________Withdrew_______________(Semester/Year) Have you ever been dropped for poor scholarship from Penn State or any other institution? Yes______ No______ Have you ever been
dismissed/suspended for disciplinary reasons from Penn State or
any other institution? Yes______ No______
If you have attended another college or university since you
were last enrolled at Penn State, please provide the name of the
school(s), the dates of attendance and the number of credits
attempted on a separate sheet of paper. Have the Registrar(s)
send an official transcript to the Office of Admissions, Station
Road, Erie, PA 16563 I state that the information I have provided above is complete and accurate. I understand that misrepresentation or omission of information may be cause for refusal or cancellation of admission. Signature_______________________ The
Pennsylvania State University is committed to the policy that
all persons shall have equal access to programs, facilities,
admission and employment without regard to personal characteristics
and related to ability, performance, or qualifications as determined
by University policy or by state or federal authorities. The
Pennsylvania State University does not discriminate against
any person because of age, ancestry, color, disability or handicap,
national origin, race, religious creed, sex, sexual orientation,
or veteran status. Direct all inquires regarding the nondiscrimination
policy to the Affirmative Action Director, The Pennsylvania
State University, 201 Willard Building, University Park, PA
16802-2801; tel. (814) 863-0471; TDD (814) 865-3175. BD: 6/99 |