MILITARY AND VETERAN OBLIGATION FORM
This form is used for students who are ordered to military service obligations. Use of this form
is described in the Eastern Michigan University Military and Veteran Obligation Policy.
(Use additional pages if necessary and attach any supporting documents)
Today’s Date: __________ Departure date: _________________ Date of potential return: ___________
Student’s Name: ______________________________________ Student’s EID: _________________
Student’s E-mail:______________________________________ Student’s phone#:_______________
Student’s Official/Primary Major(s): ______________________________________________________
Studen
t’s Minor(s):____________________________________________________________________
If not the student listed above, do you have a Power of Attorney (POA)? (Circle one) Yes No
Power of Attorney only: My name is: ____________________________ and a copy of my Power of
Attorney is attached to this form.
The student is was enrolled in ____ undergraduate graduate level courses for a
total of _______ credit hours for the Fall Winter Summer semester.
The following actions have been taken with instructors and I request the following actions be considered
with regard to any unfinished coursework.
- Course: ____________________ Requested grade*: _____________ Instructor initials: ____________
Instructor comments: ___________________________________________________________________
- Course: ____________________ Requested grade*: _____________ Ins
tructor initials: ____________
Instructor comments: ___________________________________________________________________
- Course: ____________________ Requested grade*: _____________ Instructor initials: ____________
Instructor comments: ___________________________________________________________________
- Course: ____________________ Requested grade*: _____________ Instructor initials: ____________
Instructor comments: ___________________________________________________________________
*Drop, Withdrawal, Incomplete, Actual grade
Student resides does not reside in campus housing. If applicable, request Housing and
Dining to compute pro-rated charges incurred, including meal plan option. Any remaining balance will
be refunded to the student’s account.
Student purchased did not purchase a parking permit. If applicable, parking services
should credit the cost of the permit to the student’s account.
How would you like to receive any applicable refunds:
Eagle Onecard account Bank Account Mailed check
Mailing address for mailed check: ________________________________________________________
Student’s training/deployment address (optional): ____________________________________________
If additional information is required, I or my POA, may be contacted by phone at: ___________________
Student’s unit administrator phone: ______________________and e-mail: ________________________
_______________
_______________________ ________________________________
Student’s or POA’s Signature Military and Veteran Services Rep
Financial aid may be adjusted based on federal regulations. Contact the Office of Financial Aid for
information on military deferment for federal student loans.
