The Center for Collegiate Mental Health (CCMH) 2022 Annual Report summarizes data contributed to CCMH during the 2021-2022 academic year, beginning July 1, 2021 and closing on June 30, 2022. De-identified data were contributed by 180 college and university counseling centers, describing 190,907 unique college students seeking mental health treatment; 4,688 clinicians; and 1,287,775 appointments. In this report, CCMH explores how counseling centers contribute to the academic mission of institutions by examining the risk and protective factors associated with voluntary withdrawal from school during services. This investigation was critical given the concerning national rates of "drop out" among college students. CCMH examined if any information routinely collected when students enter counseling services was associated with leaving school during services. While several variables increased the risk, students who identified as freshman/first-year status with current elevated levels of academic distress and a history of a psychiatric hospitalization were 48% more likely to withdraw from school during treatment. Several protective factors were discovered that reduce the risk of withdrawal from school, including improvement in Depression, Generalized/Social Anxiety, and overall distress symptoms during services. Most notably, when Academic Distress significantly decreased during counseling and students were concurrently participating in an extracurricular activity, they were 51% less likely to withdraw from school. The current findings highlight the critical role college counseling centers serve in supporting the academic mission of institutions. When students improve during services at counseling centers, they are more likely to persist in school. [For the 2021 report, see ED617358.]