CampusGroups

Veterans Memorandum of Understanding

Important information for transfer students and those anticipating a change of program at CWRU:
By signing this form, I acknowledge that I have submitted VA Form 22-1995, Request for Change of Program or Place of Training to the VA, defining CWRU as my place of training.

Last Name: *

First Name: *

Middle Name:

7-digit or Network CWRU ID: *

Mailing Address:

CWRU Email Address:

Phone Number:

Name of Degree Program/Associated School:

Please check all that apply:

Veteran

Reservist/National Guard Member

Dependent/Spouse of a Veteran

Active Duty Status

Please select the appropriate Chapter Number from the list below for which your benefits should be applied, according to
your Certificate of Eligibility: *

*If you selected Chapter 31, please provide the following information:

Case Worker Name:

*If you selected Chapter 31, please provide the following information:

Case Worker Email:

**If you selected Chapter 35, please provide the following information:

VA File Number:

**If you selected Chapter 35, please provide the following information:

Veteran's Name:

The completion of this form authorizes the School Certifying Official (SCO) to certify my enrollment and provide academic record information
to the Department of Veteran Affairs to ensure the receipt of Educational Training Benefits. I understand that it is my responsibility to notify
the SCO immediately upon adding, dropping, or withdrawing from a course. I assume all responsibility resulting from not complying with
policies and practices of the VA itself, as well as those of the CWRU Registrar's Office.

Signature:

Date: