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

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.