Drop/Withdrawal Questionnaire

Name(Required)

First Last

Phone(Required)

Program Attended(Required)

Did you take a Leave of Absence at any point while at IIC?

Yes

Don’t remember

Did you take part in any distance or hybrid learning at IIC due to Covid-19?

Yes

Don’t remember

Was your withdrawal from IIC due to any reasons related to Covid-19?(Required)

ie. financial hardships, medical, educational issues, or any other reason(s) that were created because of the COVID-19 pandemic?

Yes

Please upload a picture of your driver's license or CT ID(Required)

Max. file size: 20 MB.

Today's Date(Required)

Signature(Required)

Phone

This field is for validation purposes and should be left unchanged.