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eMajor Request Withdrawal Form

Complete the form below to request a withdraw from your eMajor course.   If you wish to withdraw from more than one eMajor course, you will need to complete another form--one submission per class. You will be contacted by eMajor before your withdrawal is final.

Last Name:
First Name:
Student ID #:
Daytime Phone:
Affiliate Institution:
Student Campus Email Address:
* This email address must be the one provided by your affiliate institution.

Are you receiving Financial Aid?

Please indicate all forms of Financial Aid that you receive:

HOPE Scholarship/HOPE Grant
Pell Grant
Student Loan
Veterans Benefits
Tuition Reimbursement
Tuition Waiver
Other Scholarships

Please specify which course you wish to withdraw from:

Course Prefix
Course Number
Course Section
Course Title

Survey Questions:

  1. Primary reason for withdrawing:

    If "Reason Not Listed" please specify:

    stopHave you spoken with your eMajor Instructor about this withdrawal request? 
    Please call and email your eCore Instructor now.  The contact information is listed above.  
    Have you spoken with your eMajor Student Success Team advisor for finding resources to help you in your coursework?
    Please call and email your eMajor Student Success Team advisor now for assistance.  The contact information is listed above.


  2. Please rank the following factors and their impact on your decision to withdraw form your eMajor course.

    Not a factor Somewhat of a factor Significant factor
    Do not enjoy online learning
    Got behind and could not catch up
    Subject Matter
    Technical Problems
    Too time consuming
    Difficulty in finding assignments/quizzes
    Could not find out how to get textbooks
    Instructor was slow to respond
    Personal issues (medical, career, family)

  3. Please rank your agreement with the following statements regarding your eMajor experience.
    Strongly Disagree Disagree Neutral Agree Strongly Agree
    My instructor responded to my inquiries in a timely manner.
    It was difficult for me to locate assignments and other materials in the course.
    Information regarding due dates was easy to find.
    I often felt lost in this course.
    I would take another eMajor course in the future.

  4. Please comment on the overall effectiveness of this instructor.

  5. How did you hear about us?

Submitting this form indicates that you have read, understand, and agree with the withdrawal policies of your institution.

You will be contacted by eMajor within 2 business days to follow-up on this withdrawal request. Please try to contact your eMajor Instructor and Student Success Team member in the meantime.

IMPORTANT: After clicking the "Submit" button below you will receive a submission confirmation. Please print this for your records and file away for future reference if needed. You will also receive confirmation through your email. If you do not receive a confirmation, the request DID NOT complete. Please complete the form again or call the eMajor helpline for assistance at 1-855-9EMAJOR (1-855-936-2567) or 678-839-6400.