EmailMe Form - Military Services Residency Log

Military Services Residency Log

The purpose of this form is to gather information that will allow the Office of Military Services to report your residency participation in advance of your attendance.

Complete this form only if you wish to have your residency attendance reported to the VA.

Please note, you will not have the required information necessary to complete this form until two weeks prior to your residency start date when your residency session are made available in your student portal. Also, for virtual residencies, please be sure to include pre-work and post-work wrap up time as well.

As a reminder, if you do not sumbit this form, your residency participation will not be reported.

Name *
First Last
Student ID *
Email Address
Residency Start Date *
MM / DD / YYYY
Residency End Date *
MM / DD / YYYY
To ensure that I have increased my sense of the Walden community (e.g., networking, learning Walden processes), I will: *
To increase my critical-thinking skills, I will: *
To develop my scholarship skills, I will: *
To more closely align myself with Walden’s mission of social change, I will: *
To increase my awareness of the support services available to me, I will: *
Session Information
Add the session title and date/time for each session attended at the residency.
Session Information

Session Title

Session Date

For example:
Demystifying the DBA Doctoral Study
January 1, 2016
1.5
Hours Attended
Round up to the nearest half hour.
Check to add another session
Session Information

Session Title

Session Date

For example:
Demystifying the DBA Doctoral Study
January 1, 2016
1.5
Hours Attended
Round up to the nearest half hour.
Check to add another session
Session Information

Session Title

Session Date

For example:
Demystifying the DBA Doctoral Study
January 1, 2016
1.5
Hours Attended
Round up to the nearest half hour.
Check to add another session
Session Information

Session Title

Session Date

For example:
Demystifying the DBA Doctoral Study
January 1, 2016
1.5
Hours Attended
Round up to the nearest half hour.
Check to add another session
Session Information

Session Title

Session Date

For example:
Demystifying the DBA Doctoral Study
January 1, 2016
1.5
Hours Attended
Round up to the nearest half hour.
Check to add another session
Session Information

Session Title

Session Date

For example:
Demystifying the DBA Doctoral Study
January 1, 2016
1.5
Hours Attended
Round up to the nearest half hour.
Check to add another session
Session Information

Session Title

Session Date

For example:
Demystifying the DBA Doctoral Study
January 1, 2016
1.5
Hours Attended
Round up to the nearest half hour.
Check to add another session
Session Information

Session Title

Session Date

For example:
Demystifying the DBA Doctoral Study
January 1, 2016
1.5
Hours Attended
Round up to the nearest half hour.
Check to add another session
Session Information

Session Title

Session Date

For example:
Demystifying the DBA Doctoral Study
January 1, 2016
1.5
Hours Attended
Round up to the nearest half hour.
Check to add another session
Session Information

Session Title

Session Date

For example:
Demystifying the DBA Doctoral Study
January 1, 2016
1.5
Hours Attended
Round up to the nearest half hour.
Check to add another session
Session Information

Session Title

Session Date

For example:
Demystifying the DBA Doctoral Study
January 1, 2016
1.5
Hours Attended
Round up to the nearest half hour.
Check to add another session
Session Information

Session Title

Session Date

For example:
Demystifying the DBA Doctoral Study
January 1, 2016
1.5
Hours Attended
Round up to the nearest half hour.
Check to add another session
Session Information

Session Title

Session Date

For example:
Demystifying the DBA Doctoral Study
January 1, 2016
1.5
Hours Attended
Round up to the nearest half hour.
Check to add another session
Session Information

Session Title

Session Date

For example:
Demystifying the DBA Doctoral Study
January 1, 2016
1.5
Hours Attended
Round up to the nearest half hour.
Check to add another session
Session Information

Session Title

Session Date

For example:
Demystifying the DBA Doctoral Study
January 1, 2016
1.5
Hours Attended
Round up to the nearest half hour.
Check to add another session
Session Information

Session Title

Session Date

For example:
Demystifying the DBA Doctoral Study
January 1, 2016
1.5
Hours Attended
Round up to the nearest half hour.
Check to add another session
Session Information

Session Title

Session Date

For example:
Demystifying the DBA Doctoral Study
January 1, 2016
1.5
Hours Attended
Round up to the nearest half hour.
Check to add another session
Session Information

Session Title

Session Date

For example:
Demystifying the DBA Doctoral Study
January 1, 2016
1.5
Hours Attended
Round up to the nearest half hour.
Check to add another session
Session Information

Session Title

Session Date

For example:
Demystifying the DBA Doctoral Study
January 1, 2016
1.5
Hours Attended
Round up to the nearest half hour.
Check to add another session
Session Information

Session Title

Session Date

For example:
Demystifying the DBA Doctoral Study
January 1, 2016
1.5
Hours Attended
Round up to the nearest half hour.
I understand that the VA determines payment and eligibility and the submittance of this form does not guarantee payment for residency attendance.

My hours will be reported to the VA as stated on this form and if I should have further questions regarding my GI Bill or VA payments, I am to contact the VA at #1-888-442-4551 (option 1 then 0). *
I understand and agree to this statement

Session Title
Session Date

Session Title
Session Date

Session Title
Session Date

Session Title
Session Date

Session Information