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Communication Preferences Form

This form should be used by Penn State Extension to obtain opt-in consent for marketing communications during face-to-face meetings such as events, or office walk-ins.

Important Note

This form is NOT to be used for opting a child (individual under 13 years of age) into marketing communications; and is not intended for use at youth events or for youth walk-ins.

Instructions for Use

  1. Only use this form for individuals without access to a computer or without an email address.  All others should be directed to extension.psu.edu/aboutme.  
  2. Always ensure the current version is the one downloaded and used.
  3. Open the file in Adobe and update the specific county contact information in the lower right corner before printing.
  4. Enter customer information into Salesforce CRM system within 24 hours.
PDF, 930.1 KB

This form should be used by Penn State Extension to obtain opt-in consent for marketing communications during face-to-face meetings such as events, or office walk-ins. It is not to be used for youth under 13, or for anyone who has access to complete the online form at extension.psu.edu/aboutme