Leave of Absence/Withdrawal Notification

This form must be completed in advance of taking a leave of absence or withdrawing. Please note that this form is only regarding your immigration status. You must also speak with your Dean of Students to complete the official University paperwork. 

The submission of this form will cause your F-1 status to be terminated.  You will not be able to remain in the U.S. with a terminated record.

If you are planning on taking a medical leave of absence, please be sure to read this page prior to submitting this form: Maintaining a Full-Time Course Load.

Personal Information
Leave/Withdrawal Information
The exact date of the termination will be based on the effective date you indicate on this form. You must depart the country within 15 days of the termination date.
Important Reminders
Please note that for leaves of absence of more than 5 months, you will not qualify for off-campus employment through OPT or CPT until you have again completed 3 quarters of enrollment, if you are an F-1 student. You will have 15 days to depart the U.S. from the time of the termination for authorized early withdrawal. If you are terminated for another reason, such as a suspension, you do not have a grace period to leave and you must plan to depart immediately. Please see this page for more information. REMINDER: The submission of this form will cause your F-1 or J-1 record to be terminated. You cannot remain in the U.S. with a terminated record.