Fillable 1-CPT Co Op Application Revamp Dunleavy ATI (George Mason University)

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1-CPT Co Op Application Revamp Dunleavy ATI (George Mason University)

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  • 24 check-boxes
  • 38 other fields

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File type: PDF

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Office of International Programs and Services
SUB I, 4400 University Drive MS 4C3, Fairfax, VA 22030-4444 P (703) 993-2970, oips@gmu.edu, http://oips.gmu.edu/ Last Updated: 11/20/2019
Curricular Practical Training Application Packet Part 1
Cooperative Education CPT:
Internship - Not For Credit
NOTE: To participate in non-credit Cooperative Education CPT you will need to meet advisors and complete forms for both OIPS & Career Services.
BEFORE YOU START:
You must read the important CPT information at
http://oips.gmu.edu/cpt
which includes information
about rules you must follow while you are using CPT, important dates and deadlines, and how your CPT eligibility is affected by or
can affect your academic enrollment, on-campus employment, OPT, and assistantships.
STUDENT INFORMATION & ELIGIBILITY: Completed by student
Full
Name
_______________________
G Number
_____________________________
Level
of
Study
(circle one)
Bachelors Masters PhD
Major
____________________
Phone
_______________________
Eligibility – All boxes must be checked to complete this form
□
I have completed an academic year, continuously enrolled as a degree student in F1 status, and at least one academic
term in my program of study at George Mason.
□
I have a minimum GPA of 3.0 (Graduate Students), 2.0 (Undergraduate), or 2.33 (Juris Doctor)
o
Exceptions may be considered during summer break only. Speak with an OIPS advisor to learn if you are eligible.
□
The temporary training is an integral or required part of my curriculum and I understand that if it is not I must apply for pre-
completion Optional Practical Training.
By Signing below, I confirm that:
• All information that I have provided is accurate. If any information changes after submission, I must update OIPS within 10 days.
• I have read all of the CPT information on the OIPS website and this form. I understand and agree to comply with my responsibilities.
Signature______________________________________________________Date_____________________________
PROCEDURE
&
CHECK LIST OF REQUIRED DOCUMENTS: Completed by student. ALL steps must be completed.
Complete the below steps in the order they are listed
□
STEP 1 - OIPS Advisor: Pre-Approval: Do this before completing the application. Not all positions are CPT-eligible.
Print out Part 2: The Position Description with at least 5-7 degree-specific duties and obtain stamped approval from an OIPS
advisor to proceed with your CPT application.
□
STEP 2 - Academic Advisor: Review the position description and curricular internship objectives with your Academic Advisor.
□
Obtain Academic Advisor’s signature on Part 2 - the OIPS pre-approved position description.
□
Ask your advisor to complete the Academic Information section on Part 3 of this application.
□
STEP 3 - Employer: Review your position description and training plan with your supervisor.
□
Obtain supervisor’s signature on Part 2 – the OIPS and Academic Advisor approved position description.
□
Ask your supervisor to complete the Training Information section on Part 3 of this application.
□
Ask your employer to complete the Career Services Cooperative Education Work Agreement.
□
STEP 4 - Career Services: Schedule a meeting with Victoria Suarez through Handshake. Choose the Co-Op option. Bring the
completed CPT application, completed Co-op Work Agreement with ALL sections completed, & the position description.
□
Obtain a signature from Victoria Suarez.
The above student has been approved to participate in the George Mason Cooperative Education program.
Signature of Victoria Suarez _______________________________________________Date_________________
□
STEP 5 - OIPS Front Desk: Drop off the completed and signed CPT application, Parts 1-3, with:
□
A copy of your current transcripts from PatriotWeb.
□
TRANSFER–IN STUDENTS ONLY: A copy of most recent transcripts from your previous school.
□
PHD STUDENTS ONLY who are taking 998 and required coursework: An advisor/chair letter of support, signed and on
d
epartment letterhead.
Allow up to 2 weeks for the CPT I-20. Do not begin work before receiving the CPT I-20.
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Office of International Programs and Services
SUB I, 4400 University Drive MS 4C3, Fairfax, VA 22030-4444 P (703) 993-2970, oips@gmu.edu, http://oips.gmu.edu/ Last Updated: 11/20/2019
Curricular Practical Training Application Packet Part 2
Curricular Practical Training Position Description
PART 1: Student PART 2:
Office of International Programs
and Services
(Completed before any
other steps.)
I confirm that this position description is
specific and that the student is eligible to
apply f
or CPT.
Name, Signature, Date
Part 3: Academic Advisor, Department
Head, or Dean
I confirm that this position description
includes duties and training that are integral
to the curriculum.
Name, Signature, Date
Part 4:
Training Organization
I confirm that the intern will be performing
the duties listed.
Name, Signature, Date
Enter a minimum of 5-7 degree specific responsibilities
or learning objectives in the space below.
Office of International Programs and Services
SUB I, 4400 University Drive MS 4C3, Fairfax, VA 22030-4444 P (703) 993-2970, oips@gmu.edu, http://oips.gmu.edu/ Last Updated: 11/20/2019
Curricular Practical Training Application Packet Part 3
IMPORTANT INFORMATION FOR ACADEMIC ADVISORS and SUPERVISORS:
Help us determine whether the proposed training meets government guidelines for CPT by reviewing the OIPS CPT Position
Description Form and the student's curriculum.
Student’s Estimated Graduation (Term/Year):
□
I have reviewed and signed the OIPS CPT Position Description Form and attest that the training is integral to the curriculum.
□
List relevant degree coursework to CPT (not to include future coursework). List full course names and numbers:
Please select one:
□
Student will be enrolled in a departmental internship course.
• Please list the course name and number: ________________________________________________________________
□
Student will not enroll in a departmental internship course.
• For Advisors of Thesis/Dissertation Students Only:
• Student has not completed required coursework.
• NOTE: If the student has completed required coursework and not advanced to 799/999, they must enroll i
n a
de
partmental internship course to participate in CPT.
• Has the student started 798/998? If yes, how many credits? ___
_________________________________________
• Will they be taking 998 at the time of this CPT opportunity?____
________________________________________
□
For Thesis/Dissertation Students Who Have Completed Required Coursework and Advanced to 799/999:
• The student should apply for THESIS/DISSERTATION CPT.
• If the student is applying for Thesis/Dissertation CPT, the training must be req
uired to complete the thesis or
dissertation.
*If the training is OPTIONAL, then the student is not eligible for CPT, but may be eligible for Optional Practical Training. An OIPS
advisor can provide details.
• You will need to provide a signed Advisor/Chair letter of support on department letterhead, which explains in detail
ho
w
the experience will be used in the thesis or dissertation.
□
For Module Programs:
Dates of module(s) student will be participating and enrolled in an internship course for CPT:
Start Date (MM/DD/YY) End Date (MM/DD/YY)
I confirm that this training opportunity is integral to or required for the student’s program of study. It will not delay the student’s
expected completion date as listed on the I-20.
Academic Advisor Name (Printed) Signature Date
P
osition/Title/Department Phone Number E-mail
Temporary training for curricular purposes will be offered with:
Organization Name:
Organization Address:
Physical Location (No PO Box) City, State Zip Code
Student Intern Title: Number of hours/week:
Training Start Date: Training End Date
:
□
I have signed the OIPS CPT Position Description Form that includes 5-7 duties specific to student’s major.
Supervisor Name (Printed) Supervisor Signature Date
Position/Title Phone Number E-mail
CPT is authorization to participate in temporary training that is
an integral part of an established curriculum and directly
related to
the student’s major area of study. It is not meant to facilitate employment opportunities for F1 students.
ACADEMIC INFORMATION: Completed by Academic Advisor, Department Head, or Dean
TRAINING INFORMATION: Completed by the Organization
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1-CPT Co Op Application Revamp Dunleavy ATI (George Mason University)

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Completed 26 January 2021

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