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.