Withdrawal Questionnaire

Please fill out this form if you are withdrawing from the university.

We’re sorry that you are withdrawing from Vincennes University.
The following questions will give us a better understanding of the factors involved in student withdrawal and help us do all we can to prevent or reduce withdrawals among future students.
Responses given on this form will be kept confidential and will be combined with those from other students when reported as group data. 
Deciding to withdraw from all classes may adversely affect different services at the University. It is important to explore your options to determine if withdrawal is the best choice for you.

Students who completely withdraw from all classes may be responsible for paying all or a portion of tuition and fees for the semester. You may also be required to repay money from Financial Aid as all unearned aid will be returned to the Department of Education. Please weigh all your options before deciding to withdrawal.

Title
A short description to explain the nature of a ticket.
Withdrawal Questionnaire
Semester of withdrawal
Semester of withdrawal
Please enter the year during which you are requesting to withdrawal.
Where do you reside?
Where do you reside?
Have you attended more then 1 semester?
Have you attended more then 1 semester?
Which best describes the type of classes taken during your last semester?
Which best describes the type of classes taken during your last semester?
What were your primary reasons for choosing VU? Please choose all that apply.
What were your primary reasons for choosing VU? Please choose all that apply.
Which of the following VU services have you used? Please choose all that apply.
Which of the following VU services have you used? Please choose all that apply.
When did you start thinking about withdrawing at VU?
When did you start thinking about withdrawing at VU?
What are your major reasons for withdrawing?
What are your major reasons for withdrawing?
Before you came to the office had you talked with a VU faculty or staff about this decision?
Before you came to the office had you talked with a VU faculty or staff about this decision?
Did anyone advise you to withdraw?
Did anyone advise you to withdraw?
Have you withdrawn from the university previously?
Have you withdrawn from the university previously?
Do you plan to return to VU?
Do you plan to return to VU?
What are your plans/reasons for withdrawing?
What are your plans/reasons for withdrawing?
The full details of a ticket, including any appropriate circumstances or supplementary information that may aid in resolving it.
Press Alt + 0 within the editor to access accessibility instructions, or press Alt + F10 to access the menu.

How often have you done the following this semester?

Student Information

Please enter the first, middle, and last name.
Enter Student ID / A# as A00123456
List a number where you can be reached.
Please enter a current email where you can receive correspondence.

Other Fields

Your name
Verification Code