CPT Authorization Request Form

CPT Authorization Request Form
Student Information
Name*

First NameLast Name
Phone*
Please enter a valid phone number.
Email*
Please enter a valid email address.
Date of Birth*

MonthDayYear
Date
Year of CPT Applying*
Quarter of CPT Applying (applying quarter 2025 Spring)
Degree and Major*
SEVIS ID #*
10 digits Including N

Company Information
Official Employer/Company Name*
Starting & End Date Information

Must follow the information below on your document!!

Starting Date: Jan 05 , 2026

End Date: Apr 05, 2026
Employment Start Date*

MonthDayYear
Date
Employment End Date *

MonthDayYear
Date
Hour per Week*

More than 20 Hour (Full time)20 or Less (Part time)
Job Position*
Explain how your job position is related to the major of your study(business).*
Employment / Company Address*

Street Address

Street Address Line 2

CityState

Zip Code
Address where work will take place (If different than above)

Street Address

Street Address Line 2

CityState

Zip Code
Name of Manager *

First NameLast Name

Curricular Practical Training (CPT)*

CPT Processing Fee (0.5-unit course)

$75.00 Quantity

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Job Offer Letter*

Please refer to the example
Cancelof
IMPORTANT NOTE

We will review your CPT request and Job offer letter, including your Attendance and Grades, to ensure they meet the required regulations.

Make sure to follow the CPT offer letter guidelines (refer to the sample job offer letter on our website). If any required information is missing, you will need to resubmit the letter.

It is your responsibility to follow SEVIS and CPT guidelines.

If all criteria are met, we will send you an approval notice via email. Please be patient, you can expect to receive an email from us in the next few days.
Signed Date*

MonthDayYear
Date
Signature*

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