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OPT Form
As an F-1 student on OPT, you are required by USCIS to report your employer's address and any changes while on OPT. Use this form to report those required changes as they happen.
UTA Student ID 1000
(eg. 1000123456)
SEVIS ID N
(eg. N1234567890)
First Name:
Middle Initial:
Last Name:
Email Address:
Are you Self Employed
Yes, I am Self Employed
No
If Yes provide your Occupation
Occupation:
If yes, you will need to fill out this form on a regular basis with a list of the short term jobs.
If you work for an agency or contract based employer, put the name of the agency or contract company as the name of the employer and the company/agency's address as the address.
Are you currently Employed:
Yes
No
If NO please provide the Unemployment start date
Type of OPT
12 Month OPT
17 Month OPT Please provide Supervisor's detail
If employed, please put the employment site address:
Employment Start Date:
Employer Name
Current title/position:
Supervisor Name
Supervisor Phone
e.g 1234567890 (no special character)
Supervisor email
No P.O. Box address. Must be Street Address of Employer
Address
City
State
Choose One
Alabama (AL)
Alaska (AK)
Arizona (AZ)
Arkansas (AR)
California (CA)
Colorado (CO)
Connecticut (CT)
Delaware (DE)
District of Columbia (DC)
Florida (FL)
Georgia (GA)
Guam (GU)
Hawaii (HI)
Idaho (ID)
Illinois (IL)
Indiana (IN)
Iowa (IA)
Kansas (KS)
Kentucky (KY)
Louisiana (LA)
Maine (ME)
Maryland (MD)
Massachusetts (MA)
Michigan (MI)
Minnesota (MN)
Mississippi (MS)
Missouri (MO)
Montana (MT)
Nebraska (NE)
Nevada (NV)
New Hampshire (NH)
New Jersey (NJ)
New Mexico (NM)
New York (NY)
North Carolina (NC)
North Dakota (ND)
Ohio (OH)
Oklahoma (OK)
Oregon (OR)
Pennyslvania (PA)
Puerto Rico (PR)
Rhode Island (RI)
South Carolina (SC)
South Dakota (SD)
Tennessee (TN)
Texas (TX)
Utah (UT)
Vermont (VT)
Virginia (VA)
Virgin Islands (VI)
Washington (WA)
West Virginia (WV)
Wisconsin (WI)
Wyoming (WY)
Zip Code
only the 5 digit zip code
If you have more than one employer,
please list any additional Employers you have with their addresses.