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Wichita State University | International Education | 1845 Fairmount Street | Wichita KS 67260-0122
tele: (316) 978-3232 | fax: (316) 978-3777 | e-mail: iss@wichita.edu
Authorized Early Withdrawal
F-1 Students Leaving the U.S. before Program Completion
An authorized early withdrawal is a leave of absence from the U.S. that an F-1 student may take during
their program of study for family or personal reasons. To qualify, students must be leaving the U.S.; the
student may not remain inside the country. This form must be completed in the event that a student will be
withdrawing from classes mid-semester and returning to their home country, or in the case of a student
who will not be continuing his/her program of study at WSU during the next required semester.
Student ____________________________________________________________________________
Surname(s) Given Name(s)
WSU ID _______________ E-mail _____________________________________________________
Phone Number ____________________ SEVIS ID Number (on I-20) __________________________
Your SEVIS record will be terminated for the positive reason, Authorized Early Withdrawal, based on the
option you indicate below. Students that remain in the U.S. beyond this 15 day period are considered
in violation of their F-1 status.
Please select from the following options:
□ I have decided not to continue my program at WSU effective immediately. I understand
that my SEVIS record will be terminated the same day this form is submitted to OIE and that I
have 15 days to depart the U.S.
□ I intend to complete the current term at WSU but will not return for the next semester. I
understand that my SEVIS record will be terminated on the last day of finals for the current term
and that I have 15 days from this date to depart the U.S.
By submitting this form, I certify that the information provided is true and accurate and I promise to
inform the Office of International Education immediately if my plans change. I understand that my SEVIS
record will be terminated based on the option I have indicated above, and that I have a 15-day grace period
to leave the country. I understand that I cannot work on-campus after my program withdrawal. I
acknowledge that if I have already pre-enrolled for an upcoming semester, it is my responsibility to
withdraw from my WSU classes before established withdrawal deadlines. I understand that I am financially
obligated to pay for any classes not dropped during the 100% refund period, and that a $100 late fee may
be assessed twice during the semester if I have not made any payment arrangements by the 100% refund
deadline.
Signature Date
To determine if you have any unmet obligations, contact Financial Operations at 978-3076.
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