Uniformed Services Absence
Readmission Form
To be used for eligible students returning from uniformed services duties
after an absence of greater than three consecutive academic terms.
Please submit this form along with supporting documentation to the Veteran and Military Center or RaiderConnect
1. ELIGIBILITY
A student may be eligible for readmission under 20 U.S.C. §1091c if the cumulative length of absences from Wright State University by reason of
service does not exceed five years and the readmission request is not later than three years after the period of service or not later than two years
after the end of the recovery period for a student who is hospitalized for or convalescing from an illness or injury incurred in or aggravated during
the performance of service in the uniformed services. Written notification with an intended term of enrollment is required.
2. TERM INFORMATION
Semester and year for which you seek readmission: ☐ Fall ☐ Spring ☐ Summer Year ____________
3. STUDENT INFORMATION
_______________________________ _____________________________________ _________________________ ________________________________
Last Name First Name Middle Name Previous Name(s)
____________________________________________________________________________ _________________________________________________
Street Address Wright State University ID (UID)
_______________________________ _______ _________________ _________________________________________________
City State Zip Date of Birth (MM/DD/YYYY)
________________________________ _________________________________________ _________________________________________________
Home Phone Cell Phone Email Address
Last term in attendance: (Term and Year) ___________________________________
(Note: cumulative length of absences by reason of service may not exceed five years.)
Check the box to indicate documentation that has been included with this form to confirm eligibility:
☐ DD (Department of Defense) 214 Certificate of Release or Discharge from Active Duty.
☐ Copy of duty orders prepared by the facility where the orders were fulfilled carrying an endorsement indicating completion of the
described service.
☐ Letter from the commanding officer of a Personnel Support Activity or someone of comparable authority.
☐ Certificate of completion from military training school.
☐ Discharge certificate showing character of service.
☐ Copy of extracts from payroll documents showing periods of service.
☐ Letter from National Disaster Medical System (NDMS) Team Leader or Administrative Officer verifying dates and times of NDMS
training or Federal activation.
4. ACKNOWLEDGEMENT
By signing below, I certify that the information I have provided on this form and all accompanying documentation is true and correct to the best of
my knowledge. I agree to submit additional documentation to support my circumstances as required.
_____________________________________________________________ _______________________
Signature Date
Uniformed Services Readmission applies to service members who perform service in the uniformed services, whether voluntary or involuntary, in the
Armed Forces, including service as a member of the National Guard or Reserve, on active duty, active duty for training, or full-time National Guard
duty under Federal authority (but not State authority), for a period of more than 30 consecutive days under a call or order to active duty of more than
30 consecutive days. Any student whose absence from an institution is necessitated by reason of service in the uniformed services shall be entitled to
readmission to the institution within the parameters prescribed by 20 U.S. Code § 1091c and 38 U.S.C. 4301-4334. For more information, see
https://www2.ed.gov/policy/highered/guid/readmission.html.
