OPT STEM Extension Request

Please complete the form and gather all the documents on the checklist to submit in this form. Also, please pay STEM OPT application fee ($180) to the Finance Department.

1Student Information > 2Document Upoload
Name Name First Last
SEVIS Number
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Email
Degree Information
My program of study:
OPT STEM start date. OPT STEM start date. / MM / DD YYYY
OPT STEM end date. Add 2 years minus 1 day to OPT STEM start day. OPT STEM end date. Add 2 years minus 1 day to OPT STEM start day. / MM / DD YYYY
Most recent employer information.
Name of Company
Company Address Company Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Client's Name (If applicable)
Client's Address Client's Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Job Title
Job Description
EIN (Employer Identification Number).
Must be 9 digits. Currently Entered: 0 digits.
This is a nine-digit number. NOT E-Verify #. Contact your HR if you do not know this number.
E-Verify Number
Must be between 4 and 7 digits. Currently Entered: 0 digits.
This is a four to seven digit numerical code that identifies a company's participation in the E-Verify program. Contact the HR if you do not know the number.
Employment Start date Employment Start date / MM / DD YYYY
Employment End Date Employment End Date / MM / DD YYYY
Supervisor's Last Name
Supervisor's First Name
Supervisor's Phone Number Supervisor's Phone Number - ### - ### ####
Email

OPT STEM Extension Request

OPT STEM Extension Request

Degree Information

Most recent employer information.