DUS Entry Form

Name:

Student ID #:

Date:

PSU Email:

Phone:

Entry Type

Change into DUS

DUSC/Nondegree

Readmission (after Academic Suspension)

Readmission (in good standing)

Effective Semester:

Previous College:

Current Campus:

Educational Plan: Reason for Enrollment

To prepare to enter:

To explore:

Exploratory resources (dus.psu.edu/forms/change-into-dus-worksheet.html ) have been used to consider academic options.

Maximum Time of Enrollment in DUS

Academic Performance

To meet your educational goals, you will need to achieve the following cumulative GPA and/or course grades:

Schedule Plan

To explore interests and abilities, meet entrance-to-major requirements, and make academic progress, the following course(s) should be scheduled while you are enrolled in DUS:

____________________________________

Adviser Signature

Student Signature

Recommendation by Adviser

Please provide comments in the box explaining your decision.

Approve Entry

Deny

Approval pending completion of following requirements:

Associate Director Decision:

Approve Entry

Deny Entry

Initials: _______ Date: _____________

Administrative Actions

Adviser Assignment: ______________________________

Entered by: _________________ on _______________