24 Months OPT STEM Extension Request Form

Student ID *

Name *

First Name Last Name

Phone Number *

Area Code Phone Number

E-mail Address *

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

SEVIS ID *

Program *

Are you being paid by the employer who issued your offer letter and I-983 training plan? *

Yes (I am employed/paid directly by this employer) No (I am employed/paid through a staffing agency or consultancy)

Organization Name *

Employer Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Are you working at the employer address? *

If STEM OPT will take place anywhere other than the employer address (Client site, branch of your employer, etc.), provide the EXACT NAME and ADDRESS of the work site (this should be listed in Section 5 of the I-983)

If you select 'NO' earlier, enter the Site Name or Client name, and complete address

Supervisor Name (as shown on Section 5 of I-983) *

First Name Last Name

Supervisor Phone (as shown on Section 5 of I-983) *

Area Code Phone Number

Supervisor Email (as shown on Section 5 of I-983) *

Employer EIN *

OPT Job Title *

E-Verify Number *

Description of how the position relates to degree. *

Do not copy and paste the job duties/description from the offer letter. In 4 to 5 sentences, describe how your employment is related to your major area of study in your own words. 0/200

Start Date you will begin STEM OPT with employer (This should match the "Start Date of Employment" field in Section 3 of I-983) *

Month Day Year

Is this a paid position? *

Yes No

Is this position Full Time (more than 20 hours/week) or Part Time (20 or less hours/week)? *

Full time Part time

Note: F-1 students on OPT STEM extensions are allotted 60 additional days of unemployment that are added to any of the unused unemployment days out of the original 90 days.

Please refer to this link to understand reporting obligations you must follow while on STEM OPT.

Note: You must submit your application within 60 days of the creation of your I-20 or your application with USCIS will be denied.

In making this request, I understand & agree to abide by all requirements... *

I will report all changes in my US or overseas address to ITU within 10 days of change. I will provide ITU with a copy of my EAD card upon arrival by completing OPT Reporting Form. Unemployment: For 24-month STEM OPT extension, you understand you may not accrue more than a total of 150 days of unemployment throughout your entire 36 months on OPT. Time spent outside the U.S., if not employed by a U.S. employer, is counted towards the 150 day period of unemployment. I understand that I can work up to 180 days while my case is pending with the USCIS with an expired EAD card. I will report the name & address of my employer to ITU within 10 days of starting work. I will report all periods of unemployment to ITU within 10 days. I agree to only work for an employer that has an E-Verify number. I will complete the OPT Reporting every 6 months from start date listed on the STEM EAD card. (Failure to update the STEM OPT employment information within the 6-month reporting period is considered a violation of a student’s F-1 status.) I understand that it is my responsibility to abide by the regulations governing the F-1 OPT STEM extension and to maintain F-1 status. I understand that failure to abide by the requirements will terminate your F-1 status and thus your ability to work and otherwise remain in the US

Signature *

Date *

Month Day Year

OPT EAD Card Upload *

Employment Verification Letter *

PLEASE FOLLOW THE BELOW TEMPLATE

Please refer to this employment verification letter template to follow.

For assistance with completing the I-983, please refer to the official instructions here.

Form I-983 Upload *

No E-Signature allowed on Form I-983.

24 Months OPT STEM Extension Request Form

Contact Information

Employer Information

Request