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New / Change of Employer (for students on OPT/OPT Extension)

This form is for reporting your Optional Practical Training or Optional Practical Training Extension employment information. If you are not employed and your status is actively seeking employment, please complete the End of Employment form.

First Name*
Last Name*
Student Number*
Phone Number
E-mail Address*
Current Street Address*
Zip Code*
New Employer (Company) Name*
If on OPT Extension, Provide Employer's E-verify Number
Employer Identification Number (EIN) *
Employer Address*
Employer City*
Employer State*
Employer Zip Code*
Start Date of Employment with this company (on OPT, not CPT)*
Supervisor's Name*
Supervisor's Phone Number*
Supervisor's Email
Previous Employer (Company) Name (If applicable)
End Date of Previous Employment