Fillable Cpt V2 Pp (Pepperdine University)

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Cpt V2 Pp (Pepperdine University)

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File type: PDF

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Last name ______________________________________ First name _____________________________________
CWID ____ ____ ____ ____ ____ ____ ____ ____ ____ Major _________________________________________
Telephone _____________________________________ E-mail _______________________________________
Name of employer _______________________________________________________________________________
Employer address________________________________________________________________________________
City _____________________________ State_________________________ Zip Code _______________________
I am applying for:
Part time (limited to 20 hours a week)
Full time (more than 20 hours a week)
This internship is:
Paid
Unpaid
I am not enrolled in an English as a Second Language (“ESL”) program at Pepperdine University.
I understand that if my CPT is paid, I must obtain a new Form I-20 before working.
I will pick-up my new Form I-20 before starting a paid internship.
I will submit a UPS shipping label to oiss@pepperdine.edu via e-ship global.
I certify that I have read and agree to comply with the CPT requirements on the OISS website.
Student’s Signature ____________________________________
Date _____/ _____/ _____
ACADEMIC ADVISOR
How is this CPT an integral part of the student’s academic program? _______________________________________
_______________________________________________________________________________________________
What is the course # for this internship? ______________ Term _________________ Year _________________
Expected date of program completion (NOT the date of graduation) _____/ _____/ _____
Month Day Year
CPT start date _____/ _____/ _____
Month Day Year
Month Day Year
If the CPT dates precede or exceed the term dates, please explain why this is necessary._________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Signature ______________________________________
Date _____/______/______
Name ________________________________________
Title _________________________________________
Department ____________________________________
Email ________________________________________
For office use only:
Received by ____________________________________________________________
Date ____/_____/_____
I-20 issued by ____________________________________________________________
Date ____/_____/_____
I-20 picked up by ________________________________________________________
Date ____/_____/_____
I-20 sent to student by _____________________________________________________
Date ____/_____/_____
OFFICE OF INTERNATIONAL STUDENT SERVICES
CURRICULAR PRACTICAL TRAINING (CPT)
Month Day
Year
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Cpt V2 Pp (Pepperdine University)

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Completed 25 July 2020

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