This form is to be used by F-1 students who are currently participating in OPT. All information is required unless otherwise specified. Please type N/A in the fields that do not apply to you.
Information Required by USCIS
If you work for more than one employer, you must list the contact information for ALL employers. If you have more than two, please send a separate email to firstname.lastname@example.org and indicate any additional employers not notated on this form. Type N/A if not available.
Self-employed If you are self-employed please give details of the employment and business address below in the text box.
Have you applied for another Immigration Status? (Example: H-1B, PR etc.)
If yes, what type of immigration status?
H-1B Permanent Residency Other N/A
What is the status of your immigration case?
Pending Approved N/A
Enter your case receipt number
Have you permanently departed the U.S.?
If yes, Departure Date:
Are you currently Employed?
Are you currently working as a Volunteer?
Yes No ** If you are volunteering, please submit a detailed offer letter for your volunteer work to the ISS Office. ** OPT employment cannot be reported until the ISS Office receives the employment Offer Letter for Volunteer work.
** Volunteer work must be 20 hours or more a week.
**If your employment is terminated during your OPT period please send an e-mail to email@example.com.