OPT STEM EXTENSION APPLICATION

What is the OPT STEM Extension?

The OPT STEM Extension is a 24-month extension of Post-Completion OPT work authorization for individuals who are engaged in Post-Completion OPT based on a bachelor's, master's, or Ph.D in certain STEM (Science, Technology, Engineering, Math) fields.

Who is Eligible for the OPT STEM Extension?

F-1 students who:1). Are on OPT following completion of a STEM degree (see p. 4 for a list of STEM majors at FSU)2). Are currently on post-completion OPT and have only worked for a U.S employer in a job directly related to student's STEM field listed on I-20 3). Have an employer registered with E-verify4). Under certain circumstances, earned a prior STEM degree from a currently accredited SEVP-certified school (see your F-1 advisor for details).

What is E-verify?

E-verify is a program that electronically compares information on the I-9 form with Social Security and DHS records to help employers verify identity and employment eligibility of new hires. It is currently free in all 50 states. An employer can register with E-verify atwww.uscis.gov.

When should you apply for the OPT STEM Extension?

An F-1 student may apply for the STEM Extension within 90 days of the initial post-completion OPT end date. The STEM Extension application MUST be received by USCIS before the end date of the initial post-completion OPT period. We recommend that students apply at least 90 days before the post-completion OPT end date.

When can you begin your STEM Extension work?

The STEM Extension work authorization begins on the day after the expiration of the initial post-completion OPT authorization, and ends 24 months later, regardless of the date the actual extension is approved. Students who timely file a STEM Extension application will be able to continue employment with the E-verify employer while the extension application is pending, until adjudication or for 180 days, whichever is first.

Can you remain unemployed during my OPT STEM Extension?

During this time, your F-1 status is dependent on employment. Students must not accrue an aggregate of more than 150 days of unemployment during the total 36 month OPT period.

What are your reporting requirements while on the OPT STEM Extension?

1). You must report to the CGE every 6 months following the start date of the 24-month extension by using the OPT: Update

2). You must report to the CGE (using the OPT Update Form) within 10 days if there are changes to any of the following: A change of address, a change of legal name, a change in e-mail address, a change in employer or employer address

3). You must report to the CGE any material changes to the Form I-983 (this will require a new I-983 to be submitted to the CGE)

4). STEM OPT students must fill out 2 evaluations (one within 12 months and a final evaluation at the end of the STEM period). Material changes include the following: Any change of the employer's Employer Identification Number, resulting from a change in employer's ownership or structure. Any reduction in student compensation that is not tied to a reduction in hours worked. Any significant decrease in hours per week that a student engages in a STEM training opportunity. Changes to the employer's commitments or student's learning objectives as documented on the I-983.

110 S. Woodward Ave., PO Box 3064216, Tallahassee, FL 32306-4216 850.644.1702 Fax: 850.644.9951 cge@admin.fsu.edu http://cge.fsu.edu

Center for Global EngagementFLORIDA STATE UNIVERSITY

Form found on our website, even if there is no information to update. You must report your legal name, residential or mailing address,mail address, employer name, and employer address. Students can report this information starting 15 days before the reporting date and up to 31 days after. SEVIS will automatically terminate a student's OPT and F-1 status if the student fails to report within this timeframe.

OPT STEM EXTENSION APPLICATION

Submit the material below to the Center for Global Engagement. See the box below for instructions on how to submit these supporting documents.

Steps for applying for OPT STEM Extension:

Be sure to fill out all forms in black ink only. Read the instructions carefully and submit a complete application. An incomplete packet will delay your application.

• Form I-765 ( download online at: https://www.uscis.gov/sites/default/files/files/form/i-765.pdf )• I-983 Form ( you can find the fillable form online here: https://www.ice.gov/sites/default/files/documents/Document/2016/i983.pdf)• Acknowledgment of Responsibilities• Copy of your stamped, I-94 card (copy the front & back) or Printed I-94 (printed off www.cbp.gov/I94).• Copy of your EAD card, front and back• Copy of your passport biographical page (page containing the passport number, expiration, birth date, and picture)• Copy of your F-1 visa

• Proof of the STEM Degree (copy of diploma or official/unofficial transcript)• 2 passport-style photos (https://travel.state.gov/content/passports/en/passports/photos/photo-composition-template.html)• Filing fee: Check or money order for $410.00 (Make check payable to The Department of Homeland Security).

While you are waiting to receive your application packet back from the Center for Global Engagement, prepare the following:

1) Scan the documents and e-mail them to your adviser. In your e-mail, use Subject Line: OPT Extension Application

You may submit the application to the Center for Global Engagement by using one of the three methods listed below:

2) Mail us the Required Original Documents:FSU Center for Global Engagement (OPT Extension Application) 110 S. Woodward Ave. PO Box 3064216 Tallahassee, FL 32306-4216

3) OR, drop off your application at the front desk

Advisor E-mail

You will receive your processed application packet back from your CGE adviser with the new I-20 recommending the extension. Mailing instructions and a final checklist will be included in your packet. You will mail your completed

application to the UCSIC office.

110 S. Woodward Ave., PO Box 3064216, Tallahassee, FL 32306-4216 850.644.1702 Fax: 850.644.9951 cge@admin.fsu.edu http://cge.fsu.edu

Leesa Truesdell Tan EdgertonNathan Duddles

ltruesdell@fsu.edu tedgerton@fsu.edunduddles@fsu.edu

Center for Global EngagementFLORIDA STATE UNIVERSITY

OPT STEM EXTENSION APPLICATION Acknowledgment of Responsibilities

Please initial and sign:

I understand that while I am engaged in the 24-month extension period:

______I will report a change of address within 10 days of the change to my new residence. It must be a physical street address and NOT a P.O. Box nor an office/employer address.

______I will report a change in the legal name printed on my I-20. ______I will report a change in e-mail address. ______I will report any change in employer name, supervisor name or employer address (a new I-983 form must be submitted). ______I will notify my Center for Global Engagement advisor if my job ends. ______I understand my F-1 status is dependent on my employment. I must not have a cumulative total of 150 days of unemployment over the 36-month period. ______I must also update the CGE every 6 months from the extension start date using the OPT Update Form on the CGE website. I must confirm the information listed above; even if there have been no changes. I can report as early as 15 days before my

______I will also submit 2 evaluations on progress: one within the first 12 months of the STEM start date and one at the end of my STEM extension.

Date:

To help you meet these reporting requirements, CGE has set up an online reporting form at: http://cge.fsu.edu

NOTE: Failure to report within the reporting time frame can result in SEVIS automatically terminating your OPT and F-1 status.

110 S. Woodward Ave., PO Box 3064216, Tallahassee, FL 32306-4216 850.644.1702 Fax: 850.644.9951cge@admin.fsu.edu http://cge.fsu.edu

Center for Global EngagementFLORIDA STATE UNIVERSITY

U.S. ADDRESS: This must be your PHYSICAL STREET ADDRESS or where you reside. This CANNOT be a P.O. Box or office address.

Street Address:

City: State: Zip/Postal Code:

(mm/dd/yyyy)

First Name:Student Last Name:

Signature:

Date of Birth: Non-FSU E-mail Address:

reporting date and up to 31 days after that date.

Natural Resources and Conservation (03.XXXX) • Environmental Science (03.0104)• Environmental Science and Policy (03.0104)• Environmental Science/FSU-Teach (03.0104)

Mass Communication (09.XXXX)/(41.XXXX) • Media/Communication Studies (09.0702)• Media and Communication Studies (09.0702)• Digital Media Productions (09.0702)• Public Interest Media and Communication (09.0702)

Computer and Information Sciences (11.XXXX) • Computer Science (11.0101)• Computer and Network Systems Administration (11.0101)• Information Security (11.0101)• Computer Science BA (11.0101)• Information Technology (11.0103)• Information Communication & Technology (11.0103)• Information Studies (11.0401)

Education (13.XXXX) • Instructional Systems and Learning Technologies (13.0501)• Program Evaluation (13.0601)• Measurement & Statistics (13.0603)

Engineering (14.XXXX) • Biomedical Engineering (14.0501)• Chemical Engineering (14.0701)• Chemical - Materials Engineering (14.0701)• Chemical - Biomedical Engineering (14.0701)• Civil Engineering (14.0801)• Environmental Engineering-Civil (14.0801)• Civil Engineering – MEng (14.0801)• Computer Engineering (14.0901)• Electrical Engineering (14.1001)• Mechanical Engineering (14.1901)• Sustainable Energy (14.1901)• Industrial Engineering (14.3501)• Engineering Management (14.3501)• Engineering Management in Orthotics and Prosthetics

(14.3501)

Mathematics (27.XXXX) • Mathematics (27.0101)• Applied & Computational Mathematics (27.0101)• Financial Mathematics (27.0101)• Biomathematics (27.0101)• Mathematics/FSU-Teach (27.0101)• Statistics (75.0501)• Statistical Data Science (27.0501)

Biological & Biomedical Sciences (26.XXXX) • Biological Science (26.0101)• Biology/FSU-Teach (26.0101)• Biomedical Sciences (26.0102)• Biochemistry (26.0202)• Molecular Biophysics (26.0206)• Computational Structural Biology (26.0206)• Biostatistics (26.1102)• Computational Biology – Biology (26.1104)• Computational Biology – Computer Science (26.1104)• Neuroscience (26.1501)• Exercise Science (26.0908)• Sports Sciences (26.0908)• Exercise Physiology (26.0908)• Sports Nutrition (26.0908)

Physical Sciences (40.XXXX) • Meteorology (40.0401)• Applied Geosciences/FSU-Teach (40.0401)• Chemistry (40.0501)• Environmental Chemistry (40.0501)• Materials Chemistry (40.0501)• Chemical Sciences (40.0599)• Chemical Sciences/FSU-Teach (40.0599)• Geology (40.0601)• Oceanography (40.0607)• Biological Oceanography (40.0607)• Chemical Oceanography (40.0607)• Geological Oceanography (40.0607)• Physical Oceanography (40.0607)• Aquatic Environmental Sciences (40.0607)• PSM in Aquatic Environmental Science (40.0607)• Physics (40.0801)• Physics and Astrophysics (40.0801)• Physical Science (40.0899)• Physical Science/FSU-Teach (40.0899)• Geophysical Fluid Dynamics (40.9999)• Materials Science and Engineering (40.1001)

Protective Services (43.XXXX) • Computer Criminology – Criminology (43.0116)• Computer Criminology – Computer Science (43.0116)

Social Sciences (45.XXXX) • Geographic Information Science (45.0702)

Business & Management (52.XXXX) • Actuarial Science (52.1204)

FSU Eligible STEM Majors FLORIDA STATE UNIVERSITYCenter for Global Engagement

Multi/Interdisciplinary Studies (30.XXXX) • Computational Science(30.3001)

ICE Form I-983 (7/16) Page 1 of 5

DEPARTMENT OF HOMELAND SECURITY U.S. Immigration and Customs Enforcement

TRAINING PLAN FOR STEM OPT STUDENTS Science, Technology, Engineering & Mathematics (STEM) Optional Practical Training (OPT)

OMB APPROVAL NO. 1653-0054 EXPIRATION DATE: 03-31-2019

SECTION 1: STUDENT INFORMATION (Completed by Student)Student Name (Surname/Primary Name, Given Name): Student Email Address:

Name of School Recommending STEM OPT:

Name of School Where STEM Degree Was Earned:

SEVIS School Code of School Recommending STEM OPT (including 3-digit suffix):

Designated School Official (DSO) Name and Contact Information: Student SEVIS ID No.: STEM OPT Requested Period (mm-dd-yyyy):From:

Qualifying Major and Classification of Instructional Programs (CIP) Code:

Level/Type of Qualifying Degree:

Date Awarded (mm-dd-yyyy):

Based on Prior Degree? Yes No

Employment Authorization Number:

1. I have reviewed,understand,and will adhere to this Training Plan for STEM OPT Students (“Plan”);

2. I will notify the DSO at the earliest available opportunity if I believe that my employer is not providing me with appropriate training as delineated on this Plan;

3. I understand that the Department of Homeland Security (DHS) may deny, revoke, or terminate the STEM OPT of students whom DHS determines are not engaging in OPT in compliance with the law, including the STEM OPT of students who are not, or whose employers are not, complying with this Plan;

4. My practical training opportunity is directly related to the STEM degree that qualifies me for the STEM OPT extension; and

5. I will notify the DSO at the earliest available opportunity regarding any material changes to or deviations from this Plan, including but not limited to, any change of Employer Identification Number resulting from a corporate restructuring, any nontrivial reduction in compensation from the amount previously submitted on the Plan that is not tied to a reduction in hours worked, any significant decrease in hours per week that I engage in a STEM training opportunity, and any decrease in hours below the 20-hours-per-week minimum required under this rule.

To:

SECTION 2: STUDENT CERTIFICATIONI declare and affirm under penalty of perjury that the statements and information made herein are true and correct to the best of my knowledge, information and belief. I understand that the law provides severe penalties for knowingly and willfully falsifying or concealing a material fact, or using any false document in the submission of this form.

Signature of Student:

Date (mm-dd-yyyy):

I certify that:

Printed Name of Student:

EXAMPLEx

c/o FSU CTR for Global Engagement PO Box 3064216

Tallahassee FL 32306-4216

YOU MUSTDOWNLOAD THIS FORM AT:https://www.uscis.gov/system/files_force/files/form/i-765.pdf

Enter ssn only after I-20 is issued

SIGN AFTER YOUR I-20 HAS BEEN ISSUED

C 3 C

SECTION 3: EMPLOYER INFORMATION (Completed by Employer)

A. Salary Amount and Frequency:

B. Other Compensation (Type and Estimated Amount or Value):

1.

3.

4.

2.

Start Date of Employment (mm-dd-yyyy):

SECTION 4: EMPLOYER CERTIFICATIONI declare and affirm under penalty of perjury that the statements and information made herein are true and correct to the best of my knowledge, information and belief. I understand that the law provides severe penalties for knowingly and willfully falsifying or concealing a material fact, or using any false document in the submission of this form.

I certify on behalf of the employer that this Training Plan for STEM OPT Students (“Plan”) is approved and that:

1. I have reviewed and understand this Plan, and I will ensure that the supervising Official follows this Plan;

2. I will notify the DSO at the earliest available opportunity regarding any material changes to this Plan, including but not limited to, any change of Employer Identification Number resulting from a corporate restructuring, any reduction in compensation from the amount previously submitted on the Plan that is not tied to a reduction in hours worked, any significant decrease in hours per week that a student engages in a STEM training opportunity, and any decrease in hours below the 20-hours-per-week minimum required under this rule;

3. Within five business days of the termination or departure of the student during the authorized period of OPT, I will report such termination or departure to the DSO (Note: business days do not include federal holidays or weekend days; and an employer shall consider a student to have departed when the employer knows the student has left the practical training opportunity, or when the student has not reported for practical training for a period of five consecutive business days without the consent of the employer); and

4. I will adhere to all applicable regulatory provisions that govern this program (see 8 CFR Part 214), which include, but are not limited to, the following:

a. The student’s practical training opportunity is directly related to the STEM degree that qualifies the student for the STEM OPT extension, and the position offered to the student achieves the objectives of his or her participation in this training program;

b. The student will receive on-site supervision and training, consistent with this Plan, by experienced and knowledgeable staff; c. The employer has sufficient resources and personnel to provide the specified training program set forth in this Plan, and the employer is

prepared to implement that program, including at the location(s) identified in this Plan;

d. The student on a STEM OPT extension will not replace a full- or part-time, temporary or permanent U.S. worker. The terms and conditions of the STEM practical training opportunity—including duties, hours, and compensation—are commensurate with the terms and conditions applicable to the employer’s similarly situated U.S. workers or, if the employer does not employ and has not recently employed more than two similarly situated U.S. workers in the area of employment, the terms and conditions of other similarly situated U.S. workers in the area of employment; and

e. The training conducted pursuant to this Plan complies with all applicable Federal and State requirements relating to employment.

Note: DHS may, at its discretion, conduct a site visit of the employer to ensure that program requirements are being met, including that the employer possesses and maintains the ability and resources to provide structured and guided work-based learning experiences consistent with this Plan.

Employer Name: Street Address:

North American Industry Classification System (NAICS) Code:

Employer Website URL: City:

Employer ID Number (EIN):

OPT Hours Per Week (must be at least 20 hours/week):

State: ZIP Code:

Suite:

Number of Full-Time Employees in U.S.:

Compensation:

Signature of Employer Official with Signatory Authority:

Printed Name and Title of Employer Official with Signatory Authority:

Printed Name of Employing Organization: Date (mm-dd-yyyy):

ICE Form I-983 (7/16) Page 2 of 5

SECTION 5: TRAINING PLAN FOR STEM OPT STUDENTS (Completed by Student and Employer)

EMPLOYER SITE INFORMATION

Note: for the remaining fields in this section, employers who already have an internal/pre-existing training plan in place may fill in the details based on that plan.

Student Role: Describe the student's role with the employer and how that role is directly related to enhancing the student's knowledge obtained through his or her qualifying STEM degree.

Goals and Objectives: Describe how the assignment(s) with the employer will help the student achieve his or her specific objectives for work-based learning related to his or her STEM degree. The description must both specify the student's goals regarding specific knowledge, skills, or techniques as well as the means by which they will be achieved.

Employer Oversight: Explain how the employer provides oversight and supervision of individuals filling positions such as that being filled by the named F-1 student. If the employer has a training program or related policy in place that controls such oversight and supervision, please describe.

Measures and Assessments: Explain how the employer measures and confirms whether individuals filling positions such as that being filled by the named F-1 student are acquiring new knowledge and skills. If the employer has a training program or related policy in place that controls such measures and assessments, please describe.

Official's Email:

Name of Official:

Official's Phone Number:

Official's Title:

Site Address (Street, City, State, ZIP):Site Name:

Employer Name:

Student Name (Surname/Primary Name, Given Name):

ICE Form I-983 (7/16) Page 3 of 5

Additional Remarks (optional): Provide additional information pertinent to the Plan.

SECTION 6: EMPLOYER OFFICIAL CERTIFICATIONI declare and affirm under penalty of perjury that the statements and information made herein are true and correct to the best of my knowledge, information and belief. I understand that the law provides severe penalties for knowingly and willfully falsifying or concealing a material fact, or using any false document in the submission of this form.

Employer Official with Signatory Authority - I certify that:

1. I have reviewed, understand, and will follow this Training Plan for STEM OPT Students (Plan);

2. I will conduct the required periodic evaluations of the student;*

3. I will adhere to all applicable regulatory provisions that govern this program (see 8 CFR Part 214.2(f)(10)(ii)); and

4. I will notify the DSO regarding any material changes to or material deviations from this Plan at the earliest available opportunity, including if I believe the student is not receiving appropriate training as delineated in this Plan.

Signature of Employer Official with Signatory Authority:

Printed Name and Title of Employer Official with Signatory Authority:

PRIVACY ACT STATEMENT

AUTHORITIES: Section 101(a)(15)(F) of the Immigration and Nationality Act of 1952, as amended (INA), 8 U.S.C. 1101(a)(15)(F), Section 641 of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (IIRIRA), Pub. L. 104-208, Div. C, 110 Stat. 3009-546 (codified at 8 U.S.C. 1372), Section 502 of the Enhanced Border Security and Visa Entry Reform Act of 2002, Pub. L. 107-173, 116 Stat. 543 (codified at 8 U.S.C. 1762) and Homeland Security Presidential Directive No. 2 (HSPD-2), authorize U.S. Immigration and Customs Enforcement (ICE) to collect the information requested in this form.

PURPOSE: The information collection on this form is used to assist in the administration of the STEM Optional Practical Training (OPT) extension so that Designated School Officials (DSO) can properly recommend the Student for and review and help coordinate his or her STEM optional practical training opportunity.

ROUTINE USES: The information collected on this form may be shared with: the individuals who signed the Plan, relevant DSOs acting as liaisons with the DHS, Federal, State, local, or foreign government entities for law enforcement purposes, Members of Congress in response to requests on the Student’s behalf, or as otherwise authorized pursuant to its published Privacy Act system of records notice - Privacy Act of 1974: U.S. Immigration and Customs Enforcement, DHS/ICE-001 Student and Exchange Visitor Information System (SEVIS) System of Records (https://www.dhs.gov/system-records-notices-sorns).

DISCLOSURE: The information you provide is voluntary. However, failure to provide the information requested on this form may delay or prevent participation in a STEM OPT opportunity.

PAPERWORK REDUCTION ACT

The public reporting burden for this collection of information is estimated to average 7.5 hours per response, including time required for searching existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid Office of Management and Budget (OMB) control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, send them to: U.S.Immigration and Customs Enforcement, Office of Policy, 500 12th Street SW, Washington, D.C. 20536

*See evaluation forms that follow for student’s first evaluation, to occur before the one year anniversary of the start date of the student’s STEM OPT employment authorization, and final program evaluation.

Date (mm-dd-yyyy):

ICE Form I-983 (7/16) Page 4 of 5

FINAL EVALUATION ON STUDENT PROGRESS

EVALUATION ON STUDENT PROGRESSProvide a self-evaluation of your performance, using the measures previously identified, in applying and acquiring new knowledge, skills, and competencies identified in the Training Plan for STEM OPT Students. Discuss accomplishments, successful projects, overall contributions, etc., during this review period. Address whether there are any modifications to the objectives and goals for projects, or new areas for skill and competency development.

Provide a self-evaluation of your performance, using the measures previously identified, in applying and acquiring new knowledge, skills, and competencies identified in the Training Plan for STEM OPT Students. Discuss accomplishments, successful projects, overall contributions, etc., during this review period. Address whether there are any modifications to the objectives and goals for projects, or new areas for skill and competency development.

Signature of Employer Official with Signatory Authority:

Printed Name of Employer Official with Signatory Authority:

Range of Evaluation Dates: From (mm-dd-yyyy): To (mm-dd-yyyy):

Date (mm-dd-yyyy):

Signature of Student:

Date (mm-dd-yyyy):Printed Name of Student:

Signature of Employer Official with Signatory Authority:

Printed Name of Employer Official with Signatory Authority:

Range of Evaluation Dates: From (mm-dd-yyyy): To (mm-dd-yyyy):

Date (mm-dd-yyyy):

Signature of Student:

Date (mm-dd-yyyy):Printed Name of Student:

ICE Form I-983 (7/16) Page 5 of 5

1 

Completing the Form I‐983

TRAINING PLAN FOR STEM OPT STUDENTSScience, Technology, Engineering & Mathematics (STEM) Optional Practical Training (OPT)

STEM OPT students and their employers are subject to the terms of the Form I‐983, Training Plan for STEM OPT Students, effective as of the start date requested for STEM OPT on the Form I‐983.

Section 1:  Student Information (Completed by Student):o Student Name: Enter your full name (Surname/Primary Name, Given Name) exactly as it

appears on your SEVIS (Student and Exchange Visitor Information System) issued Form I‐20,“Certificate of Eligibility for Nonimmigrant (F‐1) Student Status – For Academic andLanguage Students.”

o Student Email Address: Enter the email address where you can be contacted.

o Name of School Recommending STEM OPT: Enter the name of your school of most recentenrollment, from which the Designated School Official (DSO) will be recommending STEMOPT.

o Name of School Where STEM Degree Was Earned: Enter the name of the school from whichyou earned the degree upon which the STEM OPT is based.  This may or may not be thesame school recommending the STEM OPT if you are using a prior STEM degree.

o SEVIS School Code of School Recommending STEM OPT: Enter the SEVIS School code of theschool recommending the STEM OPT (including the 3‐digit suffix). This would be yourcurrent school or school of most recent enrollment.

o DSO Name and Contact Information: Enter the full name and contact information, includingofficial address, phone, and email, of the DSO who is recommending this STEM OPT andprocessed this Form I‐983.

o Student SEVIS ID Number: Enter your SEVIS identification (ID) number.

o STEM OPT Requested Period: Enter the period during which you are requesting to work onSTEM OPT (regardless of whether the authorized dates match actual training dates). Notethat the STEM OPT extension may not end more than 24 months after the scheduledtermination of the student’s Employment Authorization Document for the current period ofpost‐completion OPT.  For a student on 12‐month OPT requesting a STEM OPT extension,the start date should be the day after your current 12‐month OPT ends.  For a student on17‐month STEM OPT requesting conversion to the terms and conditions of a 24‐monthSTEM OPT extension, the F‐1 student and the student’s employer will be subject to theterms and conditions of the Form I‐983, “Training Plan for STEM OPT Students,” as of thedate of receipt at U.S. Citizenship and Immigration Services (USCIS) and thus the requestedperiod should identify a start date on or before proper filing at USCIS.

o Qualifying Major and Classification of Instructional Programs (CIP) Code: Enter your STEMmajor that qualifies you for the STEM OPT extension, as well as the degree’s (CIP) code.  Youcan find CIP codes on the National Center for Education Statistics website at:

2 

http://nces.ed.gov/ipeds/cipcode/default.aspx?y=55 or the ICE website at http://www.ice.gov/sevis.  

o Level/Type of Qualifying Degree: Enter the academic level upon which you are basing STEMOPT.  (For example, enter Bachelor’s, Master’s, or Ph.D.)

o Date Awarded: Enter the date when the degree, upon which STEM OPT will be based, wasawarded.

o Based on Prior Degree?  Check “Yes” if your STEM OPT participation is based on apreviously‐obtained STEM degree, and is not the same degree upon which your currentpost‐completion OPT was granted.  Check “No” if your STEM OPT participation is based onyour most recently obtained degree, and that is the degree upon which your current post‐completion OPT is based.

o Employment Authorization Number: Enter your “A” number, (which may be found on theEmployment Authorization Document).

Section 2: Student Certification:o Student Certification: Review the certification and affirm the statement by signature.

Section 3: Employer Information (Completed by Employer):o Employer Name: Enter your company, university, etc. name.

o Street Address, Suite, City, State, Zip Code: Enter the employer or company mailing address.

o Employer Website URL: Enter the employer website URL, if available. If no website exists,enter N/A.

o Employer ID Number (EIN): Enter the Employer Identification Number (EIN).

o Number of Full‐Time Employees in the United States: Provide the number of full‐timeemployees in the United States.

o North American Industry Classification System (NAICS) Code: Enter the company’s NAICScode. (Federal statistical agencies use the NAICS code to classify business establishments forthe purpose of collecting, analyzing and publishing statistical data related to the U.S.business economy.)  NAICS codes are accessible at http://www.census.gov/cgi‐bin/sssd/naics/naicsrch?chart=2012.

o OPT Training Hours Per Week: Enter the agreed‐upon number of average training hours perweek.  In order to qualify for STEM OPT, the student must work a minimum of 20 hours perweek.

o Start Date of Employment: Enter the date when the student will begin the STEM OPTtraining with the employer.

o Compensation: Enter the dollar amount of salary, stipend, and/or other compensation, andthe frequency of pay (per hour, per week, bi‐weekly, monthly).  Other compensation mayinclude housing, tuition waivers, transportation costs, etc.  Note: The terms and conditionsof a STEM practical training opportunity (including duties, hours, and compensation) mustbe commensurate with those applicable to similarly situated U.S. workers, except that aSTEM OPT participant must work at least 20 hours per week while employed.

Section 4: Employer Certification:

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o Employer Certification: The Employer Official with Signatory Authority, who is anappropriate individual in the employer’s organization, who is familiar with the student’sgoals and performance, and who is an employee who has signatory authority for theemployer should review the certification and affirm the statement by signature.

o Note for Employer Official with Signatory Authority: The Employer Official with SignatoryAuthority attestation includes the certification at Section 4 (d) which states “The student ona STEM OPT extension will not replace a full‐ or part‐time, temporary or permanent U.S.worker.  The terms and conditions of the STEM practical training opportunity—includingduties, hours, and compensation—are commensurate with the terms and conditionsapplicable to the employer’s similarly situated U.S. workers or, if the employer does notemploy and has not recently employed more than two similarly situated U.S. workers in thearea of employment, the terms and conditions of other similarly situated U.S. workers in thearea of employment.”

Section 5: Training Plan for STEM OPT Students (Completed by Employer):In order to better ensure the academic benefit and integrity of the extension, Federalregulations require each STEM OPT student to prepare and execute with his or her prospectiveemployer a formal training plan that identifies learning objectives and a plan for achieving thoseobjectives.  The STEM OPT student and his or her employer must work together to finalize theplan.

o Student Name: Enter the student’s name (Surname/Primary Name, Given Name) exactly asit appears on the student’s SEVIS‐issued Form I‐20, “Certificate of Eligibility forNonimmigrant (F‐1) Student Status – For Academic and Language Students.”

o Employer Name: Enter the employer’s name, as it appears in “Section 3: EmployerInformation.”

o Site Name: Enter the employer’s site name, which may be the same as employer name inSection 3.  However, if the student is working for a branch or subsidiary of a large entity, oranywhere other than the headquarters, provide the name of this work site.

o Site Address: Enter the exact address of the work site where the STEM practical training willtake place.

o Name of Official: Enter the name of the appropriate individual in the employer’sorganization who is familiar with, and will monitor, the student’s goals and performance.This may or may not be the same Employer Official as in Section 4.

o Official’s Title: Enter the title of the appropriate individual in the employer’s organizationwho is familiar with, and will monitor, the student’s goals and performance.

o Official’s Email: Enter the email address of the appropriate individual in the employer’sorganization who is familiar with, and will monitor, the student’s goals and performance.

o Official’s Phone Number: Enter the phone number of the appropriate individual in theemployer’s organization who is familiar with, and will monitor, the student’s goals andperformance.

o Student Role and the Training Program’s Direct Relationship to the Student’s QualifyingSTEM Degree: Describe what tasks and assignments the student will carry out during thetraining and how these relate to the student’s STEM degree.  The plan must cover a specificspan of time, and detail specific goals and objectives.

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o Goals and Objectives: Describe the specific skills, knowledge, and techniques the studentwill learn or apply; how the student will achieve the goals set out for his or her training; andthe training curriculum including the timeline.

o Employer Oversight: Explain how the employer provides oversight and supervision ofindividuals filling positions such as that being filled by the named F‐1 student.  If theemployer has a training program or related policy in place that controls such oversight andsupervision, a description of this program or policy may suffice to answer the question.

o Measures and Assessments: Explain how the employer measures and confirms whetherindividuals filling positions such as that being filled by the named F‐1 student are acquiringnew knowledge and skills.  If the employer has a training program or related policy in placethat controls such measures and assessments, a description of this program or policy maysuffice to answer the question.

o Additional Remarks.  Provide any additional pertinent information.

Section 6: Employer Official Certification:o Certification of Official with Signatory Authority:  Note: The individual who signs this

Certification need not be, but can be, the same individual who signed the EmployerCertification in Section 4.  An employee with signatory authority for the employer shouldreview the certification and affirm the statement by signature. On the material changecertification (#4), please note that material changes in the plan can include (but are notlimited to) the following: any change of Employer Identification Number resulting from acorporate restructuring, any reduction in compensation from the amount previouslysubmitted on the Form I‐983, “Training Plan for STEM OPT Students,” that is not tied to areduction in hours worked, any significant decrease in hours per week that a studentengages in a STEM training opportunity, and any decrease in hours below the 20‐hours‐per‐week minimum required under this rule.

Evaluation on Student Progress:o Student evaluations are a shared responsibility of both the student and the employer to

ensure that the student’s practical training goals are being satisfactorily met.  The student isresponsible for conducting a self‐evaluation based on his or her own training progress.  Theemployer must review and sign the self‐evaluation to attest to its accuracy.

o The student submits the first assessment within twelve months and a final evaluation thatrecaps all the training and knowledge acquired during the complete training period.

o Enter the range of the student evaluation dates (the timeline for which this evaluation isrelevant).

o The student must sign, print name, and enter date of signature.o The Employer Official with Signatory Authority must sign, print name, and enter the date of

signature to show concurrence with the assessment information that the student hasentered.