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* 1. Name

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* 2. Campus:

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* 3. Affiliate School

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* 4. Career program at Great Oaks

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* 5. Grade level

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* 6. When did you first consider withdrawing from Great Oaks?

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* 7. Did you discuss alternatives to withdrawal with anyone on campus?

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* 8. If "Yes", with whom?

For questions 8-11: What factors below influenced your decision to withdraw? Choose all that apply.

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* 9. Social environment (choose all that apply)

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* 10. Career program (choose all that apply)

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* 11. Academic classes (choose all that apply)

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* 12. Personal (choose all that apply)

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* 13. Overall, how much of a factor were social issues in your decision not to stay?

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* 14. Overall, how much of a factor was your career program in your decision not to stay?

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* 15. Overall, how much of a factor were your academic classes in your decision not to stay?

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* 16. Overall, how much of a factor were personal issues in your decision not to stay?

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* 17. Are there any additional comments you would like to share with us?

Thank you for completing this survey.

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