Forms

University Forms

  • Authorization for Access to Student Records (FERPA)

    The Family Educational Rights and Privacy Act of 1974, as Amended, accords privacy rights to students with respect to their educational records. A student may grant access to these records to a third party including a parent or guardian by the execution of this form.  This release must be signed by the student.

    Authorization for Access to Student Records (FERPA)

  • Academic Dishonesty Policy and Report Form

    Kutztown University is committed to the personal and intellectual growth of its students.  The principal context in which this growth occurs is through its academics, which is dependent upon an open and honest atmosphere of positive cooperation between faculty and students.  In order to maintain this atmosphere, professors must evaluate the academic performance of students fairly and students must demonstrate their mastery of subject matter honorably.  Any acts of academic dishonesty by students, such as plagiarism on written papers or cheating on exams undermine the educational and ethical goals of the University for its students.  Such violations are of the utmost seriousness.  It is the responsibility of all students to be aware of this policy and abide by it at all times.

    Academic Honesty Policy 

    Academic Dishonesty Report Form

  • Academic Exceptions Committee Petition

    Students with extenuating circumstances that may warrant an exception have the right to petition the Academic Exceptions Committee. This may be used for backdated withdrawal from a course, backdated withdraw from the university, an additional semester of probation for students who have been academically dismissed from the university, or other such circumstances. 

     If you wish to make an inquiry about the possibility of filing a petition, or wish to set up a zoom meeting to discuss a petition, please e-mail the student advocate, Nadia Daher, at .

     Please note: Deadlines for submitting an exceptions committee petition are firm. To avoid timing issues related to returning to school, please submit your petition at least one month before the start of the fall or spring semester.

    Academic Exceptions Committee Petition (maxient.com)

  • Certificate Program Registration Form

    The purpose of certificates is to recognize and address the growing importance of skills relevant to up and coming jobs in our economy. Kutztown University currently offers certificate in the following programs: 

    Certificate Registration Form 

  • Change of Citizenship Status Form

    The following information applies to international students who have had a change in their citizenship status after acceptance to Kutztown University.

    Please complete the Change of Citizenship Status Form and bring the completed form along with two of the following:

    1. Permanent Residency Card

    2. Social Security Card

    3. Tax ID number

    If applicable, students may need to go to the Financial and Business Services Department to declare residency.

     Change of Citizenship Status Form

  • Course Withdraw

    If you would like to withdraw from a course please send an email to from your Kutztown email including the following:

    • Your Name
    • Student ID #
    • Course Information
    • A statement asking us to withdrawal you from the class.

     A confirmation will be sent to you once you have been withdrawn.

  • Grade Appeal

    This Grade Appeal Policy provides a process for redress of a grievance between a student and a
    faculty member concerning a final grade in a course taken at Kutztown University. The policy
    addresses issues of academic fairness related to grade substantiation.

    Further steps for the The Grade Change Appeal Conditions and Procedures are outlined in Section II of Policy ACA-047

    Grade Appeal Form 

  • High School Non-Matriculated Student Registration Form

    Students currently enrolled in high school have the ability to take courses at Kutztown during the standard academic year. Once the High School Non-Matriculated Registration form is completed, the Registrar’s Office will contact the student for further information.

    A high school transcript and a letter from the student's high school counselor are required prior to registration.  

    For questions please contact: Mim Carlance -  

    High Schools currently participating in Dual Enrollment Agreements include:

    Antietam High School
    Brandywine Heights High School
    Fleetwood Area High School
    Kutztown Area High School
    Oley High School
    Reading Area High School

    High School Non-Matriculated Registration 

  • Internship or Field Experience Registration Approval Form

    Internship or Field Experience Registration Approval Form

  • Internship or Field Experience Site Approval Form

    Internship - Field Experience Site Approval Form

  • Preferred Name Change Request Form

    Kutztown University recognizes that students may wish to use a name other than their given first name as recorded on official documents and records including circumstances where student safety or productivity may be a risk. When formally requested by a student, the University may use a preferred first/given name in University documents and processes except where the use of the official legal name is required by University business or legal obligation. This option has been developed to respond to the needs of some international students, transgender student, for safety reasons, others who prefer the use of a nickname and those in the processes of legally changing their name but wish the name to be reflected in a timelier manner.

    Preferred Name Change Request Form

  • Rescinding a Graduation Application

    If a student has applied to graduate but then realizes that degree requirements will not be met, the student should complete this form. By submitting this form, the student will be reactivated to allow for course registration in future semesters. Students who would still like to participate in the commencement ceremony can complete the Participation in the Commencement Ceremony Request form. 

    Rescinding a Graduation Application

  • Student Name Address Change Form

    Students are able to change their legal name by filling out this form and providing documentation of the name change (Marriage Certificate, Court Order, Divorce Decree).  Student addresses can also be changed by using this form. 

    Student Name Address Change Form

  • Undergraduate Non-Matriculated Student Registration Form

    Students who are not currently active Kutztown University students still have the ability to take courses at Kutztown. Once the Non-Matriculated Registration form is complete, the Registrar’s Office will register the student for the requested courses.

    Undergraduate Non-Matriculated Student Registration Form

  • Veteran's Service's Enrollment Certification Request Form

    Students who receive Veteran’s Benefits are required to complete this form for each semester they take courses and wish to receive benefits. 

    Veteran's Service's Enrollment Certification Request Form

  • Verification of Enrollment Request

    This form is used to verify a student’s current or past enrollment dates, expected date of graduation, or other pertinent information contained on the student’s academic record at Kutztown University.  The form may be especially useful for insurance and loan deferment purposes. 

    Verification of Enrollment Request

  • Verification of Name Address for Diploma

    This form can be completed to make sure that a student’s diploma will be mailed to the correct physical address.  It can also be used to change the name that will be printed on the diploma.  Legal documentation, such as a birth certificate, driver’s license, or social security card is required. 

    Verification of Name Address for Diploma

  • Withdrawal or Leave of Absence Form

    Any student who will not be attending classes for either a fall or spring semester is required to withdraw or take a leave of absence from the university.  Full or part-time students in good standing (cumulative GPA 2.00+) who intend to return to Kutztown University may request a leave of absence from the university. A leave of absence may be granted for one semester, with the possibility of renewal for a consecutive semester, upon approval of the Registrar. The date the Registrar's Office receives the withdrawal form with the student's original signature is the student's official date of withdrawal from the university.  Students who do not wish to return to Kutztown University should withdraw from the university. 

    Please note that failure to complete the withdrawal process may result in failing grades in all courses being taken at the time of withdrawal. If the student completes the withdrawal process with the Registrar's Office prior to the end of the 12th week, the student will receive 'W' grades for all courses. After the 12th week, there is no permanent withdrawal from the university.

    Withdrawal or Leave of Absence Form

Undergraduate Forms

  • Academic Forgiveness Application

    The Academic Forgiveness Policy applies to any student who seeks readmission to Kutztown University after having been separated from the University for at least two years. If granted, the student will start the rest of his/her program of study with a 0.00 GPA.


    Academic Forgiveness Application

  • Approval to Enroll in a Graduate Course by A Graduating Senior Student

    Undergraduate seniors who have made application to enter a Graduate Studies program may be
    eligible to begin graduate studies early.

    • Seniors with a minimum cumulative grade point average (GPA) of 3.0 and/or special permission from the Dean of Graduate Studies, needing no more than 15 semester hours of academic credit to satisfy the requirements of their designated and declared baccalaureate degree may, with the approval of the chair(s) of the department(s) offering the graduate course(s), apply to the Dean of Graduate Studies for permission to supplement their undergraduate courses with graduate courses at either the 400 or 500 level.
    • Such graduate credits do not apply toward meeting the requirements of any baccalaureate degree, nor shall they affect the undergraduate transcript or undergraduate GPA. Graduating seniors seeking early enrollment in graduate courses must be registered for all undergraduate courses required for graduation with the baccalaureate degree prior to enrolling in approved graduate courses during second cycle graduate registration.
    • Graduate credit for a maximum of 6 semester hours of graduate work will be awarded only upon verification of completion of the baccalaureate degree.
    • Tuition for a mix of undergraduate and graduate courses will be charged at the rate established for post-baccalaureate certification students.

    Approval to Enroll in a Graduate Course by A Graduating Senior Student

  • Berks County Cross Registration Form

    A full-time student in good academic standing enrolled at a Higher Education Council of Berks County (HECBC) school (Albright College, Penn State Berks, Kutztown University, Alvernia University, or Reading Area Community College) can take one course at another HECBC school during the fall or spring semesters.  If approved, the student will pay the tuition rates of their home school for the course.

    Berks County Cross Registration Form

  • Final Exam Conflict Resolution

    If a student has a conflict of two final examinations at the same time, or three or more in one day, the student should try to resolve the conflict directly with the instructor(s) involved.  In the event that the conflict cannot be resolved informally, the student should then complete this form.  This form must be submitted to the Registrar’s Office by the end of the 10th week of the semester.

    Final Exam Conflict Resolution

  • Graduation Application for Undergraduate

    Students must apply to graduate in the semester in which they will complete all of the degree requirements for their major(s) and/or minor(s).  Without applying for graduation, students will not receive a degree! 

    Graduation Application for Undergraduate

  • Participation in the Commencement Ceremony Request

    This form may be submitted for consideration by a student who will not complete their graduation requirements in a given semester, but wishes to participate in the commencement ceremony during that semester. Students who need to complete an internship or six or less credits may be eligible to participate in the ceremony. The student’s name will not appear in the commencement program.  Students are reminded to apply for graduation in the semester they intend to complete their degree requirements. 

    Participation in the Commencement Ceremony Request

  • PASSHE Application for Visiting Student Status

    An undergraduate student in good academic standing with at least 12 credits already earned at their home university may take up to 24 credits via the Visiting Student Policy. If approval is granted, all credits and grades earned at other PASSHE universities shall be accepted by the home university and be treated has home university credits, residency, and grades. The Visiting Student Program cannot be used to repeat courses taken at the home institution.

    PASSHE Application for Visiting Student Status

  • Permit to Study at Another College

    Students in good academic standing have the ability to study at another college and transfer the credits earned to Kutztown University. Permission must be obtained prior to enrollment to guarantee the transfer of credits. Students must earn a “D” or better for credit to be accepted. Students cannot repeat a course for credit at another institution if a grade of “D” or better was earned at Kutztown University. 

    Permit to Study at Another College

  • Readmission Application

    A student who has attended Kutztown University and left can apply to be readmitted to the university for a fall or spring semester without going through the entire application process again.  Students are required to submit official transcripts from any institutions attended since the student attended Kutztown University. 

    Readmission Application

  • Repeat Approval Form

    Students are limited to a maximum of six total repeats.  Repeats of a single course will be limited to a maximum of three repeats. Once a student reaches the maximum allowed repeats, they must gain approval to repeat another course. When a student repeats a course, the credits are to be counted only once in determining the semester grade point average (GPA) and the total credits needed for graduation. The most recent grade in the course (regardless of whether it is higher or lower) will be used to calculate GPA.

    Repeat Approval Form

Graduate Forms