ࡱ> Y[X bjbj .ggXXXXXlllllwww$ X#T'EXwwwww'XXl%%%wXX%w%%:,(f}A 0KR#f##XPww%wwwww'' wwwwwww#wwwwwwwwwX :  International Student Services LEAVE FORM Rev. 05/19 Students who will take a temporary or permanent leave of absence from the University and the United States must complete this form. Name: (Last/Family Name) (First/Given Name) Student (NSU) ID Number: Local Phone Number: Expected Graduation Date: Major: NSU Email Address: Address: Immigration Status: q F-1 q J-1 q H-1B q Other I am planning to: q Leave the U.S. temporarily on (date) and return to NSU on or about (date) to complete my studies. q Participate in a study abroad program lasting a semester or longer from (date) to (date). q Withdraw permanently from NSU and depart from the United States. State reason PLEASE NOTE: If you remain outside of the U.S. for a semester or longer, you will need to re-activate your student file with the University. Visit the Office of the Registrar for a Readmit application. If you plan to remain outside of the U.S. for five or more months, you will need to renew your F-1 status by obtaining and entering the U.S. on a new I-20. Please make the request from the International Student Services. New, original, financial documentation will be required. I have read and understand the above. I certify that I will contact the International Student Services if there is a change in the above information. !",-3589QRy   ! 7 < = X ^ g n o r {nnnnnnnnbnnnhPCJOJQJ^Jh8Q>*CJOJQJ^J"hPh8Q5>*CJOJQJ^Jh$Erh8Q>*CJOJQJ^Jh8QCJOJQJ^Jh*CJOJQJ^JhPCJOJQJ^Jh8QCJOJQJ^Jh8Q5CJ\h8Q5CJ \ h8Q5\h8Q56\]h8Qjh~iNh~iNU&"-9  < = n o @ B f h  $a$$a$gd~iN     ( , 8 @ B f h l   @ B F       $ <=CKLSVZKSϹh$ErCJOJQJ^Jh8QhCJOJQJ^J h8Q5\h8Q5CJOJQJ\^Jh8Q>*CJOJQJ^Jh8QCJOJQJ h8QCJh8QCJOJQJ^J h8Q>*CJ>  @ B   =U & F`STU-FgvôôÖh4T5CJOJQJ\^JhoF5CJOJQJ\^JhP5CJOJQJ\^Jh8Q5CJOJQJ\^Jht 5CJOJQJ\^JUh8Q>*CJOJQJ^Jh8Qh8QCJOJQJ^J Signature Date Please return to: International Student Services, ɫֱ, 700 Park Avenue, James A. 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