Request to Withdraw Form

Leave of Absence or Request to Withdraw

Name * Required
First Last
Student ID number * Required
What is your city of birth? * Required
Please check that your computer does not auto-fill this field with "Boise"
Boise State Email Address * Required
I will not be attending on-campus classes starting from * Required
Please indicate when you will stop attending classes on campus.
Date I plan to leave the US (or date you left the US, if you've already left) * Required
Month
Day
Year
I would like to return to Boise State in the future * Required
- Yes
- No
Semester and Year I would like to return
I am planning to take online courses during this time away from campus * Required
- Yes
- No
Do you have a signature in the travel endorsement section of your I-20 (page 2)? * Required
- Yes
- No
What date is the travel signature? - must be mm/dd/yyyy format * Required
MM slash DD slash YYYY
I am transferring to another US university * Required
- Yes
- No
When do you plan to start at the new US university? * Required
Comments or questions for International Student Services
For example, please let us know if you would like to meet with an ISS advisor about this process.
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