H-1B Visa Cap-Gap extension application

H-1B Visa Cap-Gap Extension Information Request Form

Name:__________________________________________________________________

RIN (Rensselaer ID Number):______________________________________________

SEVIS Identification Number: N____________________________________________

Local Address:___________________________________________________________

Phone: _________________________________________________________________

Current E-mail: _________________________________________________________

Name of Employer: ______________________________________________________

Address of Employer: ____________________________________________________

City, State and Zip code:__________________________________________________

Start Date of OPT: ____________________

End Date: _________________________

Please provide a copy of EAD card.

Have you been approved for an H-1B Visa by the United States Citizenship and Immigration Service?

(Please check one) Yes ________ No ________

Please provide a copy of the H-1B Approval Notice provided by USCIS.

I certify that the above information is true and correct.

Date: _______________Signature____________________________________________

05/08

Last modified: May 13, 2008
International Services for Students and Scholars, Phone: (518) 276-6561, Fax: (518) 276-4839