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OPT Self Report Form

OPT FORM

STUDENT INFORMATION

Last Name:
First Name:
UH peoplesoft ID:
SEVIS ID:
Email:
Date Of Birth:
Phone Number:
Street Address:
Apartment Number:
City:
State:
Zip:
Are you only reporting the change of the living address?
Yes No
Are you currently on OPT or OPTX (OPT Extension)?
OPT OPTX (OPT Extension)
Is this first time reporting the employment?
yes No

OPT Card Information

EAD Start Date:
EAD End Date:
Email: Send it to Gina B McCready, with subject as "OPT Validation" .Fax Number: 713/743-5079
Have you submitted your OPT-X EAD Card?
Yes
No
OPT-X EAD card still pending, no EAD Card yet
EAD Start Date:
EAD End Date:
Email: Send it to Gina B McCready, with subject as "OPT-X Validation" .Fax Number: 713/743-5079
Reporting Date #1
Reporting Date #2
Reporting Date #3
Reporting Date #4
Reporting Date #5
Which one are your Reporting?
Do you have a Current Employer?
Yes No
Is this job self Employed position?
Yes No

Current employer information 1

Company Name:
Company EIN:
Start Date:
Is this a part-time or full-time position?
part-time(<=20 hours) full-time(>20 hours)
Is the Company Office address is your address:
yes no
Office Street Address:
APT/Suite number:
City:
State:
Zip:
Office Telephone:
Office Email Address:
Company Telephone:
Company Email Address:

Current employer information 1

Employer Name:
Employer EIN:
Job Title:
Start Date:
Is this a part-time or full-time position?
part-time(<=20 hours) full-time(>20 hours)
Emp Address:
Apt/Suite Number:
City:
State:
Zip:
Supervisor Last Name:
Supervisor First Name:
Supervisor Telephone:
Supervisor Email Address:
Is it related to your course of study?
Yes No
Please,send I-983 File to Gina B McCready, with subject as "OPT Validation" .Fax Number: 713/743-5079
Do you have one more Current Employer?
Yes No
Is this job self Employed position?
Yes No

Current employer information 2

Company Name:
Company EIN:
Start Date:
Is this a part-time or full-time position?
part-time(<=20 hours) full-time(>20 hours)
Is the Company Office address is your address:
yes no
Office Street Address:
Apt/Suite number:
City:
State:
Zip:
Office Telephone:
Office Email Address:
Company Telephone:
Company Email Address:

Current employer information 2

Employer Name:
Employer EIN:
Job Title:
Start Date:
Is this a part-time or full-time position?
part-time(<=20 hours) full-time(>20 hours)
Emp Address:
Apt/Suite Number:
City:
State:
Zip:
Supervisor Last Name:
Supervisor First Name:
Supervisor Telephone:
Supervisor Email Address:
Is it related to your course of study?
Yes No
Please,send I-983 File to Gina B McCready, with subject as "OPT Validation" .Fax Number: 713/743-5079
Do you have one more Current Employer?
Yes No
Is this job self Employed position?
Yes No

Current employer information 3

Company Name:
Company EIN:
Start Date:
Is this a part-time or full-time position?
part-time(<=20 hours) full-time(>20 hours)
Is the Company Office address is your address:
yes no
Office Street Address:
APT/Suite number:
City:
Zip:
State:
Office Telephone:
Office Email Address:
Company Telephone:
Company Email Address:

Current employer information 3

Employer Name:
Employer EIN:
Job Title:
Start Date:
Is this a part-time or full-time position?
part-time(<=20 hours) full-time(>20 hours)
Emp Address:
Apt/Suite Number:
City:
State:
Zip:
Supervisor Last Name:
Supervisor First Name:
Supervisor Telephone:
Supervisor Email Address:
Is it related to your course of study?
Yes No
Please,send I-983 File to Gina B McCready, with subject as "OPT Validation" .Fax Number: 713/743-5079
Do you have a Former Employer?
Yes No
Is this job self Employed position?
Yes No

Former employer information 1

Company Name:
Company EIN:
Start Date:
End Date:
Is this a part-time or full-time position?
part-time(<=20 hours) full-time(>20 hours)
Is the Company Office address your address?
yes no
Office Street Address:
Apartment Number:
City:
State:
Zip:
Office Telephone:
Office Email Address:
Company Telephone:
Company Email Address:

Former employer information 1

Employer Name:
Employer EIN:
Job Title:
Start Date:
End Date:
Is this a part-time or full-time position?
part-time(<=20 hours) full-time(>20 hours)
Emp Address:
Apt/Suite Number:
City:
State:
Zip:
Supervisor Last Name:
Supervisor First Name:
Supervisor Telephone:
Supervisor Email Address:
Do you have one more Former Employer?
Yes No
Is this job self Employed position?
Yes No

Former employer information 2

Company Name:
Company EIN:
Start Date:
End Date:
Is this a part-time or full-time position?
part-time(<=20 hours) full-time(>20 hours)
Is the Company Office address your address?
yes no
:
Office Street Address:
APT/Suite number
City:
State:
Zip:
Office Telephone:
Office Email Address:
Company Telephone:
Company Email Address:

Former employer information 2

Employer Name:
Employer EIN:
Job Title:
Start Date:
End Date:
Is this a part-time or full-time position?
part-time(<=20 hours) full-time(>20 hours)
Emp Address:
Apt/Suite Number:
City:
State:
Zip:
Supervisor Last Name:
Supervisor First Name:
Supervisor Telephone:
Supervisor Email Address:
Do you have one more Former Employer?
Yes No
Is this job self Employed position?
Yes No

Former employer information 3

Company Name:
Company EIN:
Start Date:
End Date:
Is this a part-time or full-time position?
part-time(<=20 hours) full-time(>20 hours)
Is the Company Office address your address?
yes no
Office Street Address:
APT/Suite number:
City:
State:
Zip:
Office Telephone:
Office Email Address:
Company Telephone:
Company Email Address:

Former employer information 3

Employer Name:
Employer EIN:
Job Title:
Start Date:
End Date:
Is this a part-time or full-time position?
part-time(<=20 hours) full-time(>20 hours)
Emp Address:
Apt/Suite Number:
City:
State:
Zip:
Supervisor Last Name:
Supervisor First Name:
Supervisor Telephone:
Supervisor Email Address:

TRANSITION INFORMATION

I left/will leave the U.S. on this date and do not plan to return and continue OPT/OPT-X
I am requesting an Cap-Gap from ISSSO
I plan on transferring to another university on
I plan on resuming classes for a new degree level at UH on
I have changed my status from F-1 to
I will email a copy of my approval notice(I-797 OR I-485) to Gina B McCready, with subject as "OPT Validation" .Fax Number: 713/743-5079
None of the above options apply to my situation at this present time.

Contact ISSSO IT person Roopa  or Lalitha  if you encounter technical difficulties while submitting your OPT Self Report.