OPT & 17 Month STEM Extension 6 Month Validation Report

OPT & 17-Month STEM Extension 6 Month Validation Report

This MUST be filled out every 6 months if you are on OPT or the 17-Month STEM OPT

Student’s Name:_________________________________________________________

RIN (Rensselaer Identification Number):______________________________________

SEVIS Identification Number: N____________________________________________

Start and End dates of OPT: _______________________________________________

Start Date of 17-month STEM OPT Extension:_________________________________

End Date of 17-month STEM OPT Extension:__________________________________

Local Address:___________________________________________________________

Phone Number:___________________________________________________________

Current E-mail Address:____________________________________________________

Name of Company/Employer:_______________________________________________

Name of Supervisor:_______________________________________________________

Address of Employer:______________________________________________________

Phone Number of Employer:________________________________________________

Have there been any changes in the above information in the last 6 months?

___ Yes ___ No

Please also provide us with a copy of your current Employment Authorization Card.

I certify that the above information is true and correct.

Date: _______________Signature____________________________________________

05/08

Last modified: Mar 27, 2013
International Services for Students and Scholars, Phone: (518) 276-6266, Fax: (518) 276-4839