24 Months OPT STEM Extension Request Form

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

Student ID *

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 *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Supervisor Name *

First Name Last Name

Supervisor Phone *

- Area Code Phone Number

Supervisor Email *

Employer EIN *

OPT Job Title *

E-Verify Number *

Description of how the position relates to degree. *

Do not copy and pasted the job descriptions or job duties.

Start Date *

- Month - Day Year

Is this a paid position? *

Yes No

Is this position full time or part time? *

Full time Part time

Note: F-1 students on OPT STEM extensions are allotted 30 additional days of unemployment that are added to any of the unused unemployment days out of the original 90 days.

Once your request has been filed, an I-20 will be created for your application. Please request how you would like to receive your I-20. *

Mail Pick-up Overnight Shipping ($50)

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Note: You must submit your application within 30 days of the creation of your I-20 or your application with USCIS will be denied.

Please make sure you understand STEM OPT Reporting Requirements before applying STEM OPT: https://studyinthestates.dhs.gov/students-stem-opt-reporting-requirements

In making this request, I understand & agree to abide by all requirements, including: (Please check all boxes) *

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. 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 failure to report employment in a timely manner could result in violation of F-1 status and jeopardize future entries and employment in the US.

Signature *

Date *

- Month - Day Year

OPT EAD Card Upload *

Offer Letter Upload *

Please provide the employment verification letter with the recent date.

Form I-983 Upload *

No E-Signature allowed on Form I-983.

24 Months OPT STEM Extension Request Form

Contact Information

Employer Information

Request

Delivery Information