GIS Withdrawal Request Form

This form is for current GIS students only. Prior to submitting this form, please be sure to have read information pertaining to refunds in the GIS Orientation Guide.

Please use the following form to withdraw from your guided independent study course. Requests must be made via this form. In order to ensure prompt processing, please provide all information requested below.

If you have any questions, please contact the Guided Independent Study Office at 319-273-2123, 800-772-1746 or

Course Information
Student Information
Questions and Comments (optional)