The Home for International Advising, Activities, and Assistance
Initial 12-Month OPT Request Form
__________________________________________
Student First Name
_______________________________________________
Student Last Name
E________________________________________
_____________________________@emich.edu
Emich E-mail Address
_______________________________________________
Personal E-mail Address
1 (______)________________________________
(Area Code)Telephone Number
__________________________________________
Current Address
_______________________________________________
Current City
State
__________________________________________
Zip code
__________________________________________
Student Major or Field of Study
_______________________________________________
Degree Level (Bachelor, Master, Ph.D.)
__________________________________________
Expected Graduation Date
Student E ID #
Optional Practical Training is intended to provide hands-on, practical work experience that is complimentary to your
academic program. An F-1 student may be eligible for 12 months OPT, provided this practical training is directly related
to your field of study, is commensurate with your educational level, and is recommended by your academic advisor.
Desired OPT start date: ______________ and end date: _________________
Fall
12/18/2014
Winter
4/27/2015
Summer
8/17/2015
First Date
for USCIS to receive application
9/19/2014
1/27/2015
5/19/2015
Last Date
for USCIS to receive application
2/16/2015
6/26/2015
10/16/2015
Earliest Employment Start Date
12/19/2014
4/28/2015
8/18/2015
Latest Employment Start Date
2/16/2015
6/26/2015
10/16/2015
Program End Date
Application
Employment
In making this request I understand and agree to abide by all requirements, including
I will report all changes in my US or overseas address to OIS within 10 days of such change
I will provide OIS with a copy of my Employment Authorization Document (EAD) upon receipt
I understand that I cannot begin working until I have my EAD card in-hand
I will report the name & address of my employer to OIS within 10 days of starting work
I know I should have health insurance coverage for the duration of my F1 status, including the OPT period
_______________________________________________________________________________________________________________________________________________________________
Student Signature
____________________________________________________________________________
Date
OPT Workshop attended on: ____________________ OIS advisor signature___________________________________________
EMU Office of International Students 244 Student Center www.emich.edu/ois
Last Updated 10/16/2014
tel: 1(734)487-3116
W:\Departments\Student Affairs\SA_OIS\Documents\MASTER\OPT\12 Month\OPT 12 Mo Request Form.docx
fax: 1(734)487-0303