ࡱ> LOK  &bjbj 4,ggV V 888LLLL4L)&   ((((((($+l.X(Q8 "   (9J)""" "88(" ("":', ( B}/.' (`)0)'R.].(.8(  "     ((   )    .         V X :  INCLUDEPICTURE "cid:image001.jpg@01D600EF.BE0D3A50" \* MERGEFORMATINET  International Student Services REQUEST FOR EXTENSION - (OPT) APPLICATION Rev. 7/2021 STUDENT SECTION - (ALL BLANKS MUST BE COMPLETED) Name________________________________________ NSU ID# __________________________ 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: 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 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 extension is approved, I understand that I am responsible for maintaining my F-1 status. I will notify the International Student Services office if I should move. I understand that the OPT extension permission is given only for the employer below, and should I wish to make any changes to this extension, I will receive authorization from the ISS office. If I am applying for an extension for OPT, I am responsible for ensuring that the employment is appropriate for my degree, as required by U.S. law. By signing my name below, I am certifying that the information provided on this form is correct, and that I have read the OPT Extension Information Application and understand the duration and limitations of my training as it relates to my F-1 status. 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