ࡱ> GIF )bjbj|| 4,ūgūgE V V 888LLLL,x$LV'*&&&&&&&$)6,X&]8"&9' 88& & :a%, %#L .% y&&'0V'%R,;<,%,8% &&wHV',V X :  International Student Services REQUEST FOR CURRICULAR PRACTICAL TRAINING (CPT) Rev. 05/2021 STUDENT SECTION - (ALL BLANKS MUST BE COMPLETED) Name________________________________________ ID# / SSN__________________________ Address______________________________________ E-mail_____________________________ ______________________________________ Major______________________________ Home Phone_________________________________ Work Phone_________________________ Level of Study qUndergraduate qGraduate Have you held a Graduate Assistantship? qYes qNo If  yes , please list the semesters: If you are a graduate student who is NOT graduating, have you completed all coursework? qYes qNo Employment is defined as the part-time or full-time rendering of services for compensation, financial or otherwise. Please answer the following questions, which will help determine whether or not you have maintained your lawful F-1 status and are eligible for the benefit of applying for CPT or OPT: I have not been employed off-campus without written authorization from the Designated School Official on my I-20, or an EAD from the United States Citizenship and Immigration Services (USCIS): qTrue qFalse I have not been employed on campus more than 20 hours per week while school was in session (fall and spring semesters): qTrue qFalse If the training is approved, I understand that I am responsible for maintaining my F-1 status. I will notify the Office of International Student and Scholar Services if I should move. I understand that CPT permission is given only for the employer below, and should I wish to make any changes to this training, I will receive authorization from the ISSS office. If I am applying for OPT, I am responsible for ensuring that the employment is appropriate for my degree, as required by U.S. law. I hereby apply for a period of practical training. By signing my name below, I am certifying that the information provided on this form is correct, and that I have read the OPT or CPT Information Form and understand the duration and limitations of my training as it relates to my F-1 status. Signature__________________________________________________ Date: _______________ Printed Name_______________________________________________  ` CURRICULAR PRACTICAL TRAINING (CPT) Name of Employer_______________________________________________________________ Supervisor_____________________________________________________________________ Address of Employer_____________________________________________________________ Phone_____________________________ CPT Dates ______________ to ______________ Position Title and Description_______________________________________________________ ______________________________________________________________________________ q Full-Time (21 or more hours per week) q Part-time (20 hours or less per week) The training is: q Required for student s degree q Being taken for credit (course #________) Advisor Approval (undergraduate students) OR Graduate Program Coordinato#/0:RSXYZ[_`apsԸ{k[QQEQhtVCJOJQJ^JhtVOJQJ^JhrhtV>*OJQJ\^Jhhr5OJQJ\^Jhr>*OJQJ\^JhNCJOJQJ^JhrCJOJQJ^JhICJOJQJ^JhtVCJOJQJ^JhtV5CJOJQJ\^Jhzp5OJQJ\^JhtV5OJQJ\^JhZohtV htVCJ jh7#h)jUmHnHu#S`a< = 6 8  & * ^ $a$< =  " 6 8  & ( * & ' *BԻԯԯhtV5OJQJ\^JhtV5CJOJQJ\htV5CJ\htV5CJ\htVCJOJQJ^JhtVCJOJQJ^JhtV>*CJOJQJ^JhtVCJOJQJ^JhtVOJQJ^JhtVCJOJQJ^JhtVOJQJ^J3 & ' *D] JLNOPQRSTU` & F$^a$$a$BD]@H' IJLMNOPQRSTUVWXYZ[\]^_`bc*ô,jhtV5OJQJU\^JmHnHuhr5OJQJ\^JhtV5OJQJ\^JhL5CJOJQJ\^JhtV5CJOJQJ\^JhLCJOJQJ^JhNCJOJQJ^JhtVCJOJQJ^JhtVOJQJ^J3UVWXYZ[\]^_`c*+|}"#rsn`*+|}"#rsRTVnp(((( ( (((((;(>(I(U(V(((*)2)3)ҽҪhr5CJOJQJ\^JhI5CJOJQJ\^JhrhtVUh,5CJOJQJ\^JhtV5CJOJQJ\^JhtV>*OJQJ^JhtVOJQJ^JhtVOJQJ^J9np(U(V(3)4)))))))))))))`gd[)r (graduate students) Students Anticipated Graduation Date: _______________________ I have reviewed the CPT program outlined above. With my signature below, I certify that the employment is an integral part of the curriculum and is required for graduation or employment is being used for course credit. Signature______________________________________________ Date__________________ Print Name and Title______________________________________________________ 3)4)I)j)p)))))))))))))))))ƿӵhtVOJQJ^Jh-{htV h[)CJ h[)5\h[)5OJQJ\^J htVCJhr5OJQJ\^JhtV5OJQJ\^JhI5OJQJ\^J21h:p)j/ =!"#h$% Dd_ 8  A,?,NSU_logo_horiz_tag_4cPicture 1NSU_logo_horiz_tag_4c"R p |i2sN#v DE)F p |i2sN#vJFIF``C    $ &%# #"(-90(*6+"#2D26;=@@@&0FKE>J9?@=C  =)#)==================================================H" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?j(8-wHԵ?KJmG#׏~'{zo>T_$_*fֹw3x0vꨁ \גkk{F)9UtE$dG*NX0EA`9 `N((((((((((_R|O_ O"I^SMTo7Gjm {c3*Dj1sڑG㑯LHeYH#ڟHzgQB[ $6bAm4N\^?za2xcDҬ)Wf%Cv={mg M޼?ix%Ll~o =CU.tm{귗LaĀG\w :2<| $`q$޵5k<V5k(C|#yRꖚjesNuYu_W,΢}3{ݖ%ߊQ8$jLu5uK}f֋llzth;r]`*ɨu]ܙ.e%aP~bqwTm5k)m@1x99:և-t˦<ѿ$~59H[aK}aZձ9=ҝ]"zy0D_Q{ߥmM-:\<>2o Lm tiʏ>B~qց86塝* x"+˩/'/u'<$O jWR&XQd~VX5,,}C@o֢O ']Йc&"9cOuҀ2ihdhQ}GP>q{V[c6G,oa[V%pX}+Ҵ;ڌgNߊƋ~&ӵ Bm.O;R$Rǩoz tKN& ?>Z -:jN?6*i\Y4 ^)cE3Y;&!\/7Rc , f[K :MM{k3+b9RH^q}iM NtvA:]}GѴ $G<NɤJZ7=s]Ir$<*v8R}Zys*2dКLG4ڽz>`G2mIҋrN,s+i1G 6\$rL籥-{ҕT|m<qZԯ&+$WDW}sZyE0xd~ja{éIAw `a#VNH4B^[ch%6S8 k]e-n|aܪ?ZǸ5 vuGidfsr0T GSj:v˭Ȱ\N%@bҸ:V˪\[B2*{S\ͧ{<[IF* 2N>c&y=sw^Н Ѷ⥓R k_6r2&@ ^"-:{m:$A7lXFqUY<7swk֠#V0DhNIWRREysybȌlfURj~{k˗ӂyW.cn':G>i{$-.<{ZU.,AJFq=? nYGv2$CPr}ɭ (((( ^yoȝ)g|?ygkmI`i(ʆ{HnF&6:VM/ߣ+jm[%JF3UuIb ym:LQLWU6s ȦEiָ\w5)õew 8#16YP1Oi kp ӭhVk1!7B+nPpGQ+cE5/\xɘnzRC4w!ut9)88mhMM|Qc7V(~W_1cx~>{byfp,OaR?ڇ>Կoif aF!mIӷK؇K<f'&m=rϿ.}?/oqv_RE*OF0iZ}!x \~߶ >§T!x \_߶ >߶ -S؃qzEOE;OEUQEQEsW:-kax_Ͱ >~4&V d$XU*)@W=wd{QE+Ȇj^^H"i\x =y#;q<qѺ#~l0ہ]1EX\ݴ-Z]NAgV}HNwBl8 Qa&^tˋ a4pJA!\9P{I,/㺚 "}<}qEXSTyyK [_j8cb>l+kPF+ON8}8, )[i M)3ǞJg=9⿺!c#zR{`)#иjC!P%H{[BĜջje̛Y0?hlOESQEx2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@66666_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH 8@8  Heading 1$@&>*>@>  Heading 2$@& 5>*<<  Heading 3$@&>*CJ<@<  Heading 4$@&>*CJDD  Heading 5$$@&a$ 5CJ"\DD  Heading 6$$@&a$ 5CJ\>@>  Heading 7$$@&a$CJ F@F  Heading 8$@&5OJQJ\^JV @V  Heading 9 $$@&a$56CJOJQJ\]^JDA D Default Paragraph FontViV  Table Normal :V 44 la (k (No List HC@H Body Text Indent ^CJ2B@2 Body TextCJ6P6 Body Text 2CJ<Q"< Body Text 3 5CJ\B>@2B Title$a$5CJ OJQJ\^JHBH M- Balloon TextCJOJQJ^JaJN/QN M-Balloon Text CharCJOJQJ^JaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vj\{cp/IDg6wZ0s=Dĵw %;r,qlEآyDQ"Q,=c8B,!gxMD&铁M./SAe^QשF½|SˌDإbj|E7C<bʼNpr8fnߧFrI.{1fVԅ$21(t}kJV1/ ÚQL×07#]fVIhcMZ6/Hߏ bW`Gv Ts'BCt!LQ#JxݴyJ] C:= ċ(tRQ;^e1/-/A_Y)^6(p[_&N}njzb\->;nVb*.7p]M|MMM# ud9c47=iV7̪~㦓ødfÕ 5j z'^9J{rJЃ3Ax| FU9…i3Q/B)LʾRPx)04N O'> agYeHj*kblC=hPW!alfpX OAXl:XVZbr Zy4Sw3?WӊhPxzSq]y 88,B*3))  Un) 8@(  V  # jJ"? B S  ?. 8LT|) tE 69 E 6933"##/:N`aapii  ABEHJJr!!lijnnpqvvww*>>"*t+ + - - . . / / 1 1 B D E b h > X Y [ ] _      T W } } ~   $9##/:NNYZ[`ahp    "*B B D E W W  j  $9v)@ C((\^`o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(v)C((\                  B u!"[)M-e3/4o6)E{8TZo-{P{NtVLy(LE? br}Izp,)jE G @D D D D XU U 8@ @ @P@Unknown G*Ax Times New Roman5Symbol3. *Cx Arial;Wingdings9. . Segoe UIC.,*{ @Calibri Light7.*@Calibri?= .Cx Courier NewA$BCambria Math"hg:g{qGMbb!h24A A  3QHP?u2!xx 3 f0144723Simon, Erika D.  Oh+'0  8 D P \hpx f0144723NormalSimon, Erika D.15Microsoft Office Word@ @+@V@\Lb ՜.+,0 hp  ɫֱA   Title  !"#$%&'()*+,-./012345789:;<=?@ABCDEHRoot Entry F#LJData 1Table,WordDocument4,SummaryInformation(6DocumentSummaryInformation8>CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q