GMS Withdrawal Form for the use of GMS Admission ONLY College* MED CollegeGMS Program* Name of GMS ProgramAction to take effect: (Semester) Spring Fall YEAR* Type of Leave Requested(Withdrawal/Deferral)* Withdrawal Deferral First Name* LAST NAME* BUID* BUID of studentPersonal Email* Telephone Number* Country (If Foreign address) Reason for LeavingName of ISSO Advisor Authorized Student Signature* Date* For Official Use Only (Withdrawal/Deferral Status Code) Exit Interview Reason Code