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change_of_campus

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									                                           PENN STATE ALTOONA
                                               CHANGE OF CAMPUS
________________________________________________________              ________________________________________________________
LAST NAME                       FIRST NAME                            PSU ID

________________________________________________________              TO CAMPUS________OR____REQUEST TO REMAIN AT AA*
LOCAL ADDRESS

________________________________________________________              FOR SEMESTER & YEAR_______________________(EX: FA06)
CITY                     STATE           ZIPCODE

________________________________________________________              MAJOR________INTENDED MAJOR________OPTION________
LOCAL PHONE NUMBER                          EMAIL


Do you plan to return to Penn State Altoona? _________
If yes, what semester do you plan to return? _________
                                                                      *Check only if you wish to remain at Altoona after Change of
                                                                      Campus is approved. List desired courses for upcoming
                                                                      semester in space below.
REASON FOR REQUEST:
_____   ACADEMIC (Please state reasons below)                _____    NON-ACADEMIC (Please state reasons below)




I understand that:
1. The primary reason that a request will be considered is the inability to make academic progress in my major.
2. My request will not be considered on the basis of housing issues. A lease should not be signed until a change of campus request
    is finalized. Penn State will not be responsible for third party contracts.
3. Relocation to University Park during the first two years of academic work is only to occur under exceptional circumstances.

_________________________________________                                      ____________________________________
STUDENT’S SIGNATURE                                                            DATE




FOR OFFICE USE: COLLEGE___MAJOR_____INTENDED MAJOR_____OPTION_____in major______
POOL________TOTAL CREDITS_______IN PROGRESS_______TOTAL CREDITS END OF CURRENT SEMESTER_________


DEPARTMENTAL SUPPORT (PLEASE CIRCLE): YES/NO                            CAMPUS DECISION: APPROVED/DENIED

SIGNATURE & DATE_______________________________                         SIGNATURE & DATE_____________________________

COMMENTS_______________________________________                         COMMENTS_____________________________________


RECEIVED REQUEST______________________________

ENTERED ON ARUSBC____________________________

APPROVED_______________________________________

DENIED/EMAILED STDT___________________________

CANCELLED REQUEST____________________________                                                                     updated 06/23/11

								
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