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Fall 2024 Drop & Withdrawal Form
Drop & Withdrawal Form
* Indicates required question
Email
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Record my email address with my response
Email
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Your answer
Student ID
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Your answer
Student's Full Name
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Your answer
What date did the student contact you about dropping or withdrawing from a course(s)?
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Your answer
Withdrawing from all courses?
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NO
Yes
Course # and section(s)
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Your answer
Course Title
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Your answer
Primary Reason for Withdrawal
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Choose
Academic G1 - Under prepared/did not commit 6 hrs. outside class
Academic G2 - Change degree/major
Academic G3 - Loss/no interest
Academic G4 - Study habits/too fast paced or difficult
Academic G8 - Other
Employment D1 - Began full-time job after the semester started
Employment D2 - Began part-time job after the semester started
Employment D3 - Change in job hours
Employmnet-D4 - Job change/transfer
Employment D5 - Loss of employment
Employment D6 - Spouse changed employment
Employment D7 - Working too many hours
Employment D8 - Other
I-Net E1 - No Internet service at the beginning of the semester
I-Net E2 - Computer or software not compatible
I-Net E3 - Prefer classroom instruction
I-Net E5 - Difficulty submitting coursework online
I-Net E8 - Other
Institutional Reason A2 - Course content conflict
Institutional Reason A3 - Administrative withdraw
Institutional Reason A4 - Pre-req not met
Institutional Reason A5 - Course previously completed
Institutional Reason A6 - Course not required for degree/major
Institutional Reason A7 - No Show (NS) not reported
Institutional Reason A8 - Other
Financial Reason B1 - Book/material cost
Financial Reason B2 - Loss internet access after the semester started
Financial Reason B3 - Family responsibilities
Financial Reason B4 - Financial Aid/scholarship not sufficient to cover cost
Financial Reason B5 - Transportation problems
Financial Reason B6 - Unexpected personal expenses
Financial Reason B8 - Other
Health/Personal Reason C1 - Self pre-existing health condition
Health/Personal Reason C2 - Immediate family
Health/Personal Reason C3 - Self new health condition
Health/Person Reason C4 - Moving outside ANC's service area
Health/Personal Reason C5 - Immediate family death
Health/Personal Reason C6 - Child care difficulties
Health/Personal Reason C8 - Other
Health/Personal I1 - COVID related
Note/additional withdrawal information
Your answer
List the instructor's name(s)
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Your answer
Has the instructor(s) been contacted?
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No
Yes
Who is completing this form?
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Your answer
A copy of your responses will be emailed to .
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