Graduate Student Cpt Coop Appplication Form (Page 2 of 2) in pdf

UH  Office of International Student and Scholar Services  University Center North in Room 203  Houston, TX 77204-3024  (713) 743-5065

F-1 GRADUATE STUDENT CPT APPLICATION FORM

Step 1: Student Information and statement

Family name:

Given name

Student ID:

Major:

Degree:  Master’s  Doctorate

Thesis/Dissertation:  Yes  No

Expected graduation:

Request effective for (semester/year):

Will you have a graduate assistantship during this semester?  Yes  No

Will you have a DSTF during this semester?  Yes  No

Email address:

Copy the statement in the space below: I will not start CPT until I have received CPT authorization on my I-20 and I will only work during the authorized

period on page 2 of the I-20.

Signature:

Date:

Phone:

Step 2: Student Request

Curricular Practical Training (CPT):  Part-time (20 hrs/week or less)  Full-time (summer only or authorized final semester)

Select one of the following:

 Required practicum or internship course. Note: Only requires Academic Advisor signature for Step 4 unless RCL is requested*

 Required research for thesis / dissertation (i.e. essential to completion of thesis or dissertation).

 CPT COOP (i.e. Cooperative Education Program)

I am requesting a CPT start date of ______________________ AND I have registered for classes for the next semester, including summer, as applicable.

Reduced Course Load (RCL) while participating in CPT in my final semester (*All signatures are required for step 4) - I am requesting a:

 Reduced course load for Non-Thesis Track: I anticipate this is my final semester and I only need ____hours of course work to complete my

degree program. If I fail to complete my degree as expected, I understand that I maybe in violation of my legal status and may need to apply for

reinstatement.

 Full-time equivalency for Thesis track: I am expecting this semester to be my final semester. I have completed all course work and I am only

working on my thesis or dissertation. I am allowed to take ____hours of thesis or dissertation. If I fail to complete my thesis/dissertation I will be

required to take 9 hours in subsequent main semesters.

Note: Taking a RCL or full-time equivalency for SEVIS tracking will disqualify you for any graduate assistantship position and DSTF.

Step 3: Employer Statement of Understanding (Please attach job offer letter)

Dear Employer: The above named student is applying for employment under the U.S. Citizenship and Immigration Service (formerly the INS) program called

Curricular Practical Training (CPT). The application will be reviewed by an authorized Designated School Official (DSO) at UH. Authorization will be made after

review of the student’s records, your job offer letter, and this application. Your job offer letter should contain the job title, a basic description of job duties, hours of

employment per week, job location, the start date, and ending date (if known). Some CPT will be structured under the UH Cooperative Education Program (COOP).

Other CPT may involve registering for a required course. Work authorization for this student must be renewed each semester. The proof of authorization will

be a typed authorization on p. 2 of the student’s SEVIS (Student & Exchange Visitor Information System) generated I-20. This I-20 information, including the

employer name, will be in the SEVIS records (see page 31 of the I-9 Employer Handbook for a sample I-20). The student will receive a grade for the CPT. The

signature below does not obligate the employer in anyway. It is a statement of understanding about the nature of the student’s authorization to work. It may take 5-10

working days to complete the authorization process.

“As the employer (or representative thereof), I understand that the authorization for this employment will be through the CPT program. I have attached a

job offer letter. Employment is contingent on the student producing proper work authorization each semester.”

Employer _____________________________ Signature ____________________________ Title ________________________ Date___________

Step 4: Academic Certifying Signatures

Academic Approval: I have reviewed the student’s job offer letter and believe that it represents a valid training opportunity that is related

to the student’s major. Please check “Approved” or “Not Approved”.

Academic Advisor:

Date:

Comments:

 Approved

 Not approved

Signature:

 Approved