* indicates required field

Personal Information
* Last (Family) Name:
* First (Given) Name:
Middle Name:
Graduation Year:
* SEVIS number
(upper right corner of I-20, starts with "N"):
Student ID#:
* Current Email Address:
Current Residential Address
(This must be a physical residential address and not a PO Box)
* Street Address:
Street Address:
* City:
* State:
* Zip:
OPT Employment information
(Required to select one option)
* I am Currently Employed
Job Title:
Name of employer:
Street Address:
City:
State:
Zip:
* I am self employed
Type of business:
Business Address (can be personal address):
City:
State:
Zip:
* Currently have EAD card, but I am not currently employed. I am actively seeking employment:
* I have permanently left the country and have no intention of completing OPT: