Re-enrollment Request Form
Please complete and submit the form below to request re-enrollment to Portland State University.

This form cannot be accepted if a PSU ID is not provided. If you do not remember your PSU ID please contact the Office of the Registrar at 503-725-3220 or to inquire about the steps required to retrieve it.

Your answer
Last Name *
Your answer
First Name *
Your answer
Middle Name *
Type in "None" below if you do not have a middle name.
Your answer
Previous Name(s) *
Enter other names your account may be under (i.e. maiden name). Enter "None" below if not applicable.
Your answer
Date of Birth *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
Current Address *
Example: 724 SW Harrison Street, Portland OR 97207
Your answer
What term do you plan on returning? *
We will email you the associated registration dates for the term selected below.
Have you attended other institutions? *
Please list all schools you attended after leaving PSU, otherwise enter "None" below.
Your answer
Have you earned an associate's degree or higher since leaving PSU? *
Please enter the type of degree and date earned, otherwise type "None" below.
Your answer
Never submit passwords through Google Forms.
This form was created inside of Portland State University. Report Abuse