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InternationalProgramsOffice,1CollegeDrive,Bentonville,AR72712

Website:https://nwacc.edu/web/lss_internationaladmissions/

Phone:479‐619‐2224Email:internationalprograms@nwacc.edu

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CPT Advisor Form

STUDENT: ________________________________________ NWACC ID: ______________________________________

Your advisee is requesting authorization to be employed under Curricular Practical Training. To better evaluate the student’s request,

please assist the International Programs Office by completing the following information. Once you have completed the form, please

return it to the student to be submitted to our office for review. Under no circumstances should any of the information below be

completed by the student. If you have questions or concerns, please contact the ISL Office: 479-619-2224 or jyoumans@nwacc.edu.

Thank you for your assistance.

DEGREE WORKING TOWARDS: AAS AS AA CERTIFICATE

I certify that I have reviewed the student’s proposed title and job duties, determined the proposed employment directly

relates to the student’s field of study, and confirmed the proposed employment will enhance the academic development of the

student.

Academic credit is a requirement of Curricular Practical Training authorization.

Course Title: ____________________________________

Course Number: __________________________ Term: ___________________________

Faculty member assigned to teach course/evaluate work: ____________________________________

Date proposed CPT employment will end: ________________________________

If that date extends beyond the end of the term, I agree to file an incomplete for the student’s coursework until ALL

employment has been completed and evaluated.

Who will register the student in the course? Student  Academic Advisor

I recommend the student be authorized for the proposed employment.

___________________________________________________________________________ ________________________

ADVISOR/INSTRUCTOR NAME DATE

___________________________________________________________________________

SIGNATURE

________________________________________________ ________________________ _________________________

POSITION TITLE PHONE NUMBER E-MAIL

*All employment days must be evaluated for the registered course credit in order to fulfill CPT requirements. It is the academics

advisor’s/professor’s role to determine if the proposed employment meets department requirements.

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