1.	Student Name:*

2.	Student ID:*

3.	Email Address:

4.	Home Phone:

5.	Cell Phone:

	We would like to help students stay in school. To do that, we need to know why students withdraw from classes. Please take a few minutes to carefully respond to each of the following questions as honestly and completely as possible. Thank you for your help.

6.	Why did you decide not to continue your studies at FSCC? (check all that apply)
	Financial difficulties    Work schedule conflict    Medical problems    Transfer to a 4 yr. institution    FSCC too far from home    Moved out of area    Transfer to a 2 yr. institution    Coursework too difficult    Lifestyle change(marriage, pregnancy, etc.)    Graduated    Family/personal problems    Other, please specify

7.	What was your primary educational objective when first enrolling at FSCC?
	Prepare to transfer to another college or university    Earn an Associate degree    Prepare to enter the job market    Improve skills for your present job    Prepare to change careers    Other, please explain

8.	If you checked #1 in the previous questions, please indicate the college or university that you will be transferring to.

9.	Did you achieve your FSCC educational objective?
	Yes, completely    Yes, partially    No(if no, briefly explain why not)

10.	Which type of financial assistance did you receive?(check all that apply)
	Pell Grant    Scholarship    Workstudy program    Student loan    Applied, but did not receive    I did not apply for assistance    None