Office of the Registrar
Military Service PE Waiver Form
Last Name
First Name
M.I.
Date
Street
City
State
Zip
SSN(000-00-0000)
E-mail
I hereby make application for the following:
A waiver of two(2) quarter hours of PE activity courses (effective June 19, 1995), since I have served a minimum of six consecutive months on active duty in the military service (exclusive of National Guard or Reserve drills or summer camps).
ATTACHED IS A COPY OF MY DD214 (Discharge) showing the following:
Date of entry into active service:
Date of separation/discharge:
Length of service:
My degree program at WOU is:
My major is:
FOR OFFICE USE ONLY
This is to certify that
is entitled to a waiver of two (2) quarter hours in PE activity courses because of military experience, in accordance with the official record attached.
Date:
Approved by:
, Registrar.
Date recorded on permanent record:
by:
.
