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Program of Interest:
Computer Networking Technology
 Criminal Justice
 Associate of Arts
 Human Services
 Health Care Administration
 Logistic & Transportation

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Classes start every 4 weeks
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Withdraw Request Form

Program: ex. AA, BUS, CNT, CJ, HSV, HCA, MDT, LTM
I want to withdraw from the following course(s):
Select the Course:
Select the Course:
Select the Course:
Name:
Phone #: ex. 5159559874
Address:
City:
State:
Zip Code:
Your Email:
Student ID #:
If you don't know your Student ID number, go to WebAdvisor to find it.
 
Reason for Withdrawal: Please choose each reason that applies to you:
Please check all that apply
I found the course too difficult
I fell behind in my coursework
I didn't find the course materials interesting
The pace/workload was too great
I needed more contact with tutors
I didn't have the study skills/background knowledge required
I didn't have the required motivation
I didn't have the cofidence to carry on
I decided to take another course elsewhere
I underestimated the study time required
   
Lack of time for study due to:
Please check all that apply
General/work pressure
Increased pressures at home
Increased pressures at work
   
Barriers preventing successful study:
Please check all that apply
Personal Illness
No quiet place to study
Problems with access to a computer
Lack of support from family/friends
Lack of support from employers/colleagues
I have a new job/promotion
Any other reason - Please explain
   
Please Explain
   
Reasons for Study - Which of the following best describes your original reason for choosing to study this course?
Please check all that apply
Job related/promotion
Personal development
Job related/promotion and personal development
   
Do you plan to continue with your studies?
Choose one:
Yes, I plan to continue. Please reschedule me for the next start date
   
No, I need to take a break from classes. I will contact my Enrollment Counselor for available re-entry dates.
   
No, I have given up my studies at Iowa for good
   
Administrative Withdrawal (Staff Use Only - NOT FOR STUDENTS)
   
   
Name:
Student ID:
 
On your withdraw form, you verified your intent to re-enroll with Iowa Central. Students who plan on returning their next available start date are required to provide written confirmation of that intent by the Department of Education. This written confirmation must be provided at the time of withdraw.
   
Please choose your desired start date:
   
By signing below, you are indicating your intention to continue on. If you are not returning to the next start date following your current classes, please contact Krystal Crandall (515-574-1095) or Kathy Lawler (515-574-1092) in the Financial Aid office to determine how this will affect your aid. Depending on your return date, a Return of Title IV funds may be processed on your account which could result in a balance due.
   
Signature:
Date:
   
   
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