Course Name: Online or Telecourse (circle one) Course Number: ______________
Name of Instructor: Today's Date: ________________
Before withdrawing from this course, did you:
1. attend an on-campus orientation? A. yes B. no c. not applicable
2. take any quizzes, tests, or exams? A. yes B. no c. not applicable
3. submit any written assignments? A. yes B. no c. not applicable
4. contact your instructor? A. yes B. no c. not applicable
5. contact the Distance Learning office to discuss the course, instructor, etc.? A. yes B. no c. not applicable
6. contact the Learner Support Center? A. yes B. no c. not applicable
7. contact any other FCCJ office?
Which best describes your reason(s) for withdrawal from the Online Course? Please use the comment space at the bottom of the sheet for comments and further explanation.
8. Was not interested in subject matter A. yes B. no c. not applicable
9. Family obligations or illness A. yes B. no c. not applicable
10. Job commitments or business travel A. yes B. no c. not applicable
11. Poor service from FCCJ (if yes, please explain at bottom) A. yes B. no c. not applicable
12. Poor service from instructor (if yes, please explain at bottom) A. yes B. no c. not applicable
13. Enrolled in too many courses during the term A. yes B. no c. not applicable
14. Course was more work than expected A. yes B. no c. not applicable
15. Instructor suggested withdrawal A. yes B. no c. not applicable
16. Thought the course had unfair requirements A. yes B. no c. not applicable
17. Experienced some technical problems (if yes, please explain at bottom) A. yes B. no c. not applicable
18. Felt learning style was not suited for a Distance Learning Course A. yes B. no c. not applicable
19. Would rather take the course on campus A. yes B. no c. not applicable
20. Would you enroll in another FCCJ Distance Learning Course? A. yes B. no c. maybe
21. Please rate the following student support services 1 (Poor) 2 (Average) 3 (Good) 4 (Excellent)
Learner Support Center 1 2 3 4
Library 1 2 3 4
Career Development 1 2 3 4
Enrollment Services 1 2 3 4
Advising 1 2 3 4
Comments: