Lakeshore Student College Withdrawal Form

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Lakeshore Student College Withdrawal Form

Date:

Student ID Number:

First Name:

Last Name:

Preferred Email:

My top reason for deciding to leave Lakeshore College is:

(select one)

Other reasons for deciding to leave Lakeshore College are:

(select any additional reasons that may apply)

What could Lakeshore College have done to help you stay enrolled?

(select all that apply)

Did you speak with anyone prior to your decision to leave Lakeshore College?

(Select all that apply)

Family Member/Friend

Instructor

Program Counselor/Advisor

No one

Other (please explain):

Are you planning to return to Lakeshore College in the next 12 months?

Is there anything else you would like to share with us about your experience at Lakeshore College?

Lakeshore College does not discriminate against protected classes, including but not limited to race, color, national origin, religion, sex, or gender – including sexual orientation, gender identity, gender expression, disability or age in employment, admissions, or its programs or activities. To handle inquiries regarding Lakeshore's nondiscrimination policies, contact the Educational Support Services Manager (students) 920.693.1120, nicole.yang@gotoltc.edu / Executive Director of Human Resources (staff/others) 920.693.1158, marissa.holst@gotoltc.edu. 1290 North Avenue, Cleveland, WI 53015. TTY 711 gotoltc.edu/equal-opportunity-statement

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