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| First Name: |
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| Student ID (V number) : |
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| Personal E-Mail Address: |
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| 1.0 Factors That Impacted Your Decision to Withdraw |
1.1 Please select ALL the reasons that impacted your decision to withdraw from Volunteer State.
Hold down ctrl key when making multiple selections |
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| 1.2 Prior to your first semester at Volunteer State, did you complete the Directions Orientation program? |
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| 1.3 How likely are you to return to Volunteer State? |
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| 1.4 If you do not return to Volunteer State, do you plan to enroll in another institution? |
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| If yes, please indicate where? |
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| 1.5 Was there anything we could have done or provided to help you stay in school? |
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| If "Yes", please indicate what we could have done below. |
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| 2.0 Demographics |
| 2.1 Marital status: |
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| 2.2 Did you work at a job while attending Volunteer State? If you respond "No", please go to question 2.4. |
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| 2.3 How many hours a week did you work? |
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| 2.4 What was the distance you had to travel one-way to campus? |
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| 3.0 Satisfaction with Services |
3.1 Please select all programs, services or departments you used.
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3.2 If you were dissatisfied with any of the programs, services or departments listed below, please select the program and explain the situation in the box beneath the list?(optional)
Hold down ctrl key when making multiple selections |
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| 3.3 Were you registered with the Office of Disability Services? If you respond "No", please go to question 3.5. (optional) |
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| 3.4 Did you use any or all of the accommodations for which you were approved, and what was your experience with these accommodations? (optional) |
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| If "Yes", what was your experience with these accommodations?
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| 3.5 Are there any other comments/suggestions you wish to make concerning your time at Volunteer State? Please click "Submit" to record your survey and have your withdrawal form processed. (optional) |
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