Southeast Missouri State University
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1
2Senior Seminar – Military-based Substitution
School of University Studies
Student Name: _________________________________________ Southeast Student ID number: S0__________________
Local/Mailing Address: __________________________________________________________________________________
Street
City
State
Zip
Telephone Number: ____________________ Email: _______________________________ Academic Advisor: _____________________________
Degree_________________________
Major _____________________________________
Minor ____________________________________
MILITARY SERVICE:
Complete the section above, as well as this section. Take this form and your service documentation to the Office of Military and Veteran Services
(OMVS). You may fax this form and your documentation to 573-986-4973; or, you may email these items to veterans@semo.edu.
B
S
C
Y
S
Y
RANCH OF
ERVICE
OMPONENT
EARS OF
ERVICE
EARS CREDITED TOWARD
□ A
□ A
RMY
CTIVE
RETIREMENT
□ N
□ R
AVY
ESERVE
□ A
□ N
F
G
IR
ORCE
ATIONAL
UARD
__________________________
__________________________
□ M
C
ARINE
ORPS
VERIFICATION OF STATUS PROVIDED BY:
Completed by the Office of Military and Veteran Services (OMVS); initial next to the type of document used to verify years of service and retirement credit, and sign below.
Notification of Eligibility for Retired Pay letter
DD Form 214
AHRC Form 249-E
Other
REFLECTIVE ESSAY SCORING:
Student: Please enter your essay title and the word count only. The Center for Writing Excellence (CWE) staff will score your essay and forward it to University Studies Director.
Title of Reflective Essay:
Word Count:
_
_
_
___________________________________________________
___________
_________
Initial score:
Credit______
No Credit_________
Rewrite due by: ________
Second score: Credit______
No Credit_______
Attach your reflective essay, in a sealed envelope, when you submit this form to OMVS directly (by mail or in person); if you are faxing or
emailing this form, send both (form and essay) to univstudies@semo.edu. Instructions for the essay are on page 2 of this form.
Academic Integrity Statement:
__________I attest that I am the sole author of this essay, which is based on my personal experiences during my military service.
Student initials here
Student Signature __________________________________________________________Date________
Office use only
Comments:
OMVS Verification completed by ______________________________________________Date________
Center for Writing Excellence (CWE) Verification completed by ______________________Date________
Approved/Denied, Director, School of University Studies ___________________________Date________
Registrar Office action completed/rejected ______________________________________Date________
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