International Student - Withdrawal Request Form

Full Name*

Date of Birth*

Student ID #*

SEVIS ID Number*

UWG Email*

@westga.edu

Visa Type*

F-1

J-1

What is the End-Date on Your I-20 or DS-2019*

Degree Level*

Bachelors

Masters

Doctorate

Last Term of Enrollment at UWG?*

Fall

Spring

Summer

I Plan to Depart the US Before What Date?*

Flight Number

State the Reason(s) for Your Withdrawal*

*ISAP cannot process this request until they are aware. It is your responsibility to communicate your plans.

Name of Advisor*

Advisors Email*

@westga.edu

Have You Shared Your Withdrawal With Your Advisor?*

Yes

No

Plan to Return to UWG to Complete Your Program?*

Yes

No

Not Sure

Statement of Understanding

I understand that I must not withdraw or drop below full-time enrollment without prior approval by ISAP. I also understand that once ISAP terminates my record in SEVIS for “approved early withdrawal”, this action cannot be reversed, and I must depart the U.S. within 15 days. If my record is terminated for any other reason, I must depart the U.S. immediately.

Signature

Please enter your full name below to act as your signature.

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