Report OPT Employment

Required fields are marked with an asterisk (*)

Personal Information

Last (Family) Name:*

First (Given) Name:*

Middle Name:

Graduation Year:

SEVIS Number (upper right corner of I-20, starts with "N"):*

Student ID#:

Phone:*

Email Address:*

Current Residential Address
(This must be a physical residential address and not a PO Box)

Street Address:*

Street Address 2:

City:*

State:*

Zip:*

OPT Employment Information
(Required to select one option)

I am Currently Employed:*

Yes

Full or Part-Time:*

Full-time (more than 20 hours/week)

Part-time (20 hours or less/week)

Job Title:*

Explain how employment is related to your course of study:*

Employer Name:*

Employer Identification Number (EIN):

Start Date:*

If employed previously and you have ended that employment, provide the Last Date of Employment:

Employer Street Address:*

Employer City:

Employer State:

Employer Zip:*

Supervisor Information

Last Name:*

First Name:*

Phone:*

Email Address:*

Self-Employment Information

I am Self Employed:

Yes

Type of Business:

Business Address (can be personal address):

City:

State:

Zip:

Currently have EAD card, but am not currently employed. I am actively seeking employment:

Yes

I have permanently left the country and have no intention of completing OPT:

Yes

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