Application for F-1 OPT STEM Extension 

Student Name:                       SEVIS ID#:      

Personal Email:                       Day Phone:            

Work Email:     

Current Residential Address:    

Your position title:                                      

 Employer Information: 

Employer Name:  

Company Mailing Address:   

Name of Current Supervisor (or HR rep.):     

 Supervisor Email:                        Supervisor Phone #:   

 Student’s Certification:
I hereby request the ISSO to issue me a Form I-20 in support of my application to extend my OPT based on my completion of a STEM field program. I have read the instructions and I certify that I am to the best of my knowledge eligible for this extension.

I certify that I will apply for my OPT extension with the appropriate USCIS Service Center before my current EAD expires and within 30 days of the ISSO issuing my new Form I-20.  

I certify that I will update the ISSO (by email or ISSO webpage) as soon as one of the following circumstances exist:
 I change my address or contact information (US residence, email, phone, permanent residence in home country)
 I change my legal name
 I change my nonimmigrant status
 I change my job status (quit work, am fired or laid off, am relocated, change or add employers, etc.)
 I complete my employment and return to my home country 

I also certify that I will verify my continued OPT status via the ISSO OPT Validation Website every six months beginning with the date of my STEM Extension EAD. I understand that my OPT and/or SEVIS record may be terminated if I do not verify my information with ISSO every 6 months, if I am unemployed more than 90 days, or if I do not fulfill my F-1 reporting and status requirements.