Please fill in the following information in order for Student Accounts to process your petition request.*
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PSU ID Number:*
Student's Name:*
Date of Birth:*
Phone Number:
eMail Address:*


Please give full explanation indicating what action you would like the Student Collection Department to take. Attach supporting documentation or statement, if applicable.
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Portland State University Student Collections 503.725.3440 ext 2
724 SW Harrison, Portland, Or. 97201