Application for CPT Authorization
Part One: Completed by the Student
____________________
Given Name (First Name)
____________________
Full-time or Part-time CPT
____________________
Expected Graduation Date
Undergraduate Graduate
____________________
Family Name
___________________
Student ID Number (T00000000)
____________________
Major of Study
Current Level of Study:
Please read the following:
I understand that I may not begin employment under Curricular Practical Training (CPT)
until the ISS endorses my I-20.
I understand that I may only work during the period indicated on my I-20 and only for the
employer listed on my I-20.
I understand that I must register for the relevant academic course as indicated by my
academic advisor. If I withdraw from that course, I understand that I must cease
employment immediately or I will be in violation of the F-1 status.
If I am authorized for part-time CPT, I understand that I must maintain a normal full
course of study and may not exceed 20 hours of work per week in any given week during
my CPT authorization period.
If I am authorized for full-time CPT, I understand that I must maintain a full course of
study if my CPT is during the fall or spring semesters.
____________________ ____________________
Student Signature Date
Signing here acknowledges that you have read, understand, and agree to the above statements.
Part Two: Completed by the Academic Advisor
The above named student is requesting authorization to be employed off-campus under
Curricular Practical Training (CPT) for the internship/work experience required for his or her
program of study. Your assistance is necessary to process this request. Should you have any
questions, please feel free to contact the ISS at 479-964-0832 or imsso@atu.edu. Thank you for
your assistance.
1. Is the student’s proposed employment site and work plan acceptable as a means of
completing the internship or work experience course?
Yes No
2. Academic credit is a requirement of CPT. Please provide information about the class:
Course number: _______ Course title: ________________ Term enrolled: _________
____________________
Advisor’s Signature
____________________
Date
Part Three: Completed by the Employer
The above named student is requesting authorization to be employed off-campus under
Curricular Practical Training (CPT) for the internship required for his or her program of study at
Arkansas Tech University. Your assistance is necessary to process this request. Should you
have any questions, please feel free to contact the ISS at 479-964-0832 or imsso@atu.edu.
Thank you for your assistance.
1. ____________________________________________
Employer’s Name
2. _______________________________________________________________________
_______________________________________________________________________
Employer’s Physical and/or Mailing Addresses
3.
Date Scheduled to Begin* Date Scheduled to End**
*Students may not begin working until their I-20 has been endorsed for CPT authorization by the ISS in
compliance with immigration regulations.
**The end date can be no later than the end date of the semester for which CPT is authorized.
4. How many hours per week will the student work?*** _____hours
***CPT may be granted on either a full-time or part-time basis depending on the requirements for the
internship/work experience and the student’s graduation requirements. Immigration law defines “part-
time” as 20 hours per week or fewer (not to exceed 20 hours at any time) and “full-time” as 21 hours per
week or more.
Please sign below and attach an offer of employment letter which includes a
description of the proposed job duties. Thank you again for your assistance.
____________________
Employer’s Representative Signature
____________________
Date
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