Student Withdrawal Survey
(Name, ID and Gender are optional.)
Name
First Name
Last Name
SC ID Number
Gender
Male
Female
N/A
Please list all sports and/or activities in which you were involved:
Why did you choose to enroll at Southwestern College?
*
Why are you planning to leave the college? To help Southwestern improve its programs, please indicate how important each of the following influenced your decision to withdraw from SC.
*
Very Important
Somewhat Important
Not Important
N/A
Don't like living in the residence hall
Commute is too long
Want to live closer to home
Problems with roommate
Must take care of children
Problems with time management
No friends at SC
Campus life
Academic Reasons:
*
Very Important
Somewhat Important
Not Important
N/A
Academics too challenging/grades lower than expected
Curriculum did not offer enough academic challenge
Interested in area of study that SC did not offer
Not enough academic support
Not prepared for college level courses
Financial or Employment Reasons:
*
Very Important
Somewhat Important
Not Important
N/A
Need to work full-time
Did not qualify for financial assistance
Can't financially afford to continue
With whom did you discuss your decision to withdraw:
*
Fellow student
Tutor
Faculty member
Advisor
Coach
Career Services
College staff member
My employer
My relative
No one
What are your plans for the near future? How can we be of assistance with them? (e.g., transferring, working, returning to SC in the future). Also add any additional information in this box as needed.
Date
-
Month
-
Day
Year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Minutes
AM
PM
AM/PM Option
Submit
Should be Empty: