EXTENSION APPLICATION
FOR OPTIONAL PRACTICAL TRAINING
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Send needed
documentation to Virginia Tech: |
Send application materials to USCIS: |
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o Copy of Current EAD |
o
Completed I-765 |
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o Copy of completed I-765 form |
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Copy of current EAD card |
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o OPT Extension application (this form) |
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Copy of diploma or
proof of graduation |
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Copy of passport ID page and any extensions |
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A
new I-20 for OPT extension will be issued after above documents are submitted
to Virginia Tech. |
o
Copy of I-94 card
(front and back) o
Newly issued I-20 for
Extension of OPT |
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Copies of ALL I-20
forms, pages 1 & 3 |
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Two color photos that
meet the I-765 requirements |
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o
OPT Fee (check payable
to U.S. Dept. of Homeland Security) |
Download I-765 and instructions
and complete in blue ink http://www.uscis.gov/files/form/I-765.pdf
Last
name:_____________________________________________________________First Name:
_____________________________ Student ID #___________________
Date
of Birth: ____________________ SEVIS #: N____________________________ E-mail:
_____________________________
Telephone: _______________________
Local Address in
Student Job Title:
__________________________________ Supervisor’s name and contact
information_________________________________________________________
Current Employer
(name and address) _____________________________________________________________________________________________________________
Work Location
Address:________________________________________________________________________Employer
E-Verify Number:___________________________
Please give the following information about your
dependents. Attach additional page if necessary.
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Name
(SURNAME, Given name) |
Date
of Birth |
Country
of Birth |
Gender
(M/F) |
Relationship |
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I
understand that my degree must be in an approved STEM field; my employer must
be registered in E-VERIFY; and I must report information to the DSO every six
months starting from the date the extension begins and ending when the F-1
status ends. The reporting requirement is to verify that my name and address,
employer name and address, and/or loss of employment are current and accurate.
The report is due to the DSO within 10 business days of each change of
information. I understand that, if I am unemployed for 120 days during the OPT extension
period, my eligibility for OPT terminates.
I
have read all the information regarding the extension of Optional Practical
Training and reporting requirements.
Signature _________________________________________________________________ Date ____________________
Please
return this form:
Undergraduate students:
Graduate students: International Graduate Student
Services,
National Capital Region
campus:
For Office Use Only: SHATERM last
term enrolled____________ SZADEGR Major_______________________ SZAHOLD____ GOAINTL updates__________
Beginning of OPT extension: _______________________
End of OPT extension:_____________________________________