Application For Visiting Graduate Student Status Form - Pennsylvania' State System Of Higher Education

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Application for Visiting Graduate Student Status

Pennsylvania’ State System of Higher Education

 Yes

 No

Have you been accepted into a graduate program at your home university?

 Yes

 No

Are you in good standing (academic, judicial, and disciplinary)?

The Visiting Student policy requires that you answer Yes to both questions listed above. If you are unable to answer Yes to both questions,

you are not eligible to take a course(s) invoking the policy at this time.

Part I – To be filled out by student applying for visiting graduate student status

 Hispanic or Latino

 Not Hispanic or Latino

Social Security No: __________________

What is your Ethnicity?

What is your race? Mark one or more races to indicate what you consider yourself to be:

 American Indian or Alaska Native

 Asian

 Black or African American

 Native Hawaiian or Other Pacific Islander

 White

Name (First, Middle, Last): ______________________________________________________

Cell/Day Phone No: ________________

University/Local Address: _____________________________________________________________________________________

Email Address: _______________________________________________________________________________________

Legal/Permanent Address: _____________________________________________________________________________

US Citizen:  Yes

 No

Legal PA Resident?  Yes (County: __________________________________)

 No

Student’s Home University: ____________________________________________________________________________

University Visiting: _________________________________________ Semester/ Year: ___________________________

List the course(s) you intend to enroll in as a visiting graduate student:

Home University Course Equivalency

Visiting University Course

Comments

My signature acknowledges that I have spoken with my advisor or department chair and have approval to transfer the course(s) listed above to my home institution; have read

and understand the Visiting Student policy; understand that visiting student status does not guarantee housing at the visiting university; and authorizes the release of my

transcript by the visiting university to my home university. I also understand that the grades will be accepted in full by my home university and will be included in my home

university credits, GP, and residency.

_________________________________________

___________________________

Student’s Signature

Date

_________________________________________

___________________________

Advisor or Department Chair Signature

Date

Part II: The information listed in part I is accurate and has been verified by the Registrar or Dean of the student’s home university

___________________________________

___________________________