Student Exit Interview

This Exit Interview form is to be completed by any student who plans to complete this semester, but will
not be returning to William Jewell for the next semester. This form is developed for your convenience. It is
designed to:

assist you in exiting the College and to help you understand the expectations associated with
your exit.

assist William Jewell in evaluating efforts to meet the needs of the student body.

Residential students must complete this form in order to receive room deposit refund. Please know that
any information shared will remain confidential and only the student name will be distributed to offices on
a need-to-know basis.

Note: All fields marked with an * are required.

subject kings@w illiam.jew Student Exit Interv http://jw w .jew ell. Back to the Jew e #FFFFFF

Student Exit Interv

Student Information

First Name *

Last Name *

Jewell E-mail Address *

Are you a Commuter or a Residential student?

Social Security # *

Gender Female Male

Race *

Religious Preference

First generation college student? Yes No

Premanent Address *
City *

State Zip *

Class Status

First-Year

Sophomore

Junior

Senior

Graduate

Current Program
B.A. or B.S. (scroll for major) *
--choose one--

Activities you were involved in (please check all that apply)

CUA

Greek Organization

CSM

Athletics

BSA

Unity

Intramurals

Honors Organization
 Language Organization

Other

Is there a faculty/staff/administration member that you developed a

significant relationship? Yes No

Reasons for Leaving Jewell
Please help us to understand the circumstances supporting your
decision to leave William Jewell. You may check all that apply.

Transferring to: (required only if transferring)

School *

City or Town *

To major in *

Reason for transfer *

Residence Hall Experience (please explain)

Personal (please explain)

Medical Reasons (please explain)

 Financial Reason (please explain)

Campus Climate (please explain)

Adjustment Issues (please explain)

--choose one--

Military

Academic Difficulties

Other (please explain any other reason that has influenced your
decision to leave William Jewell) *

Do you plan to return to William Jewell in the future? Yes No

If yes, please specify the semester and the year.

Was it ever your intention to complete your education (earn your degree)

at William Jewell? Yes No

Are there ways Jewell could have better served you? Please be specific.
Check out Procedures:

If you have registered for next semester, please be sure to cancel

your registration through the Registrars Office.

Residential Students need to follow the Residence Hall Check-Out

Policy. Must do this through an RA or your RD.