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Cptug - NSU UG CPT Application

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3301CollegeAve|FortLauderdale,FL33314
HorvitzAdministrationBuilding,Room253
+1(954)262‐7240|intl@nova.edu
www.nova.edu/internationalaffairs
UndergraduateCPTApplicationPacket
Document:CPTUG/Revised:March2018
Undergraduatestudentsmusthavebeen“lawfullyenrolledonafull‐timebasisforonefullacademicyear”atan
eligibleinstitutionbeforetheyareeligibleforCPT.
INSTRUCTIONS:
ThispacketistobecompletedAFTERstudentshavereceivedapprovalfortheirAcademicorExELInternship.
SubmitthisentirepackettotheOfficeofInternationalAffairs.
YourpacketwillbereviewedandyourCPTI‐20willbeprocessedwithinsevenbusinessdays.
Processingtimeassumesallinformationhasbeencompletedfullyandcorrectly.Errorswillresultinadditional
delays.
‐Page1–TOBECOMPLETEDBYALLAPPLICANTS
Tobecompletedbythestudent
‐Page2–TOBECOMPLETEDFORACADEMICCREDITCPTAUTHORIZATION
Tobecompletedbythestudent&academicadvisor 
‐Page3–TOBECOMPLETEDFORExELINTERNSHIPCPTAUTHORIZATION
Tobecompletedbythestudent&careeradvisor
‐Page4–TOBECOMPLETEDBYALLAPPLICANTS
Tobecompletedbythestudent
ToBeCompletedbyAllApplicants
PartI:StudentInformation[TOBECOMPLETEDBYTHESTUDENT]
First
(Given)
Name:
Last(Family)
Name:
NSUN#: SEVISID: N
Emailaddress: @mynsu.nova.edu U.S.Telephone:
CurrentAddress:
(Street,City,State,Zip)
PartII:CPTAuthorizationType[TOBECOMPLETEDBYTHESTUDENT]
□ Option A
Academic Credit Internship:
I will be enrolled in a course and receive academic credit for CPT.
Complete Pages 1, 2, & 4
[do not complete page 3]
□ Option B
ExEL Internship:
I will use CPT to earn one or more unit for the mandatory ExEL
requirement.
This option is only available to students under catalog year 2017-18 and beyond.
Complete Pages 1, 3, & 4
[do not complete page 2]
2
OptionA:ToBeCompletedOnlyByAcademicCreditInternshipsCPTApplicants
PartIIIa:ConfirmationofUnderstanding
[TOBECOMPLETEDBYTHESTUDENT]
Readandinitialnexttoconfirmyouragreementwitheverystatement.Ifyoudonotunderstandanyofthe
informationspeaktoanInternationalStudentAdvisorbeforeinitialingandsubmittingyourapplication.
Applicationswithoutinitialsnexttoeverystatementwillnotbeaccepted.
______ I confirm that I have been “lawfully enrolled on a full-time basis for one full academic year” at an eligible
institution. I understand that receiving CPT authorization and engaging in CPT without meeting eligibility requirements is
a status violation and may impact future USCIS applications.
______ I understand and confirm that I will not begin training until I have received my new, CPT-authorized I-20. Starting
work before I have received my new, CPT-authorized I-20 is a status violation and cause for termination.
______ I understand CPT will be authorized per the dates on the job offer letter or the dates of the term in which the CPT occurs
(plus subsequent break), whichever is shorter.
______ I understand that I must re-apply for additional CPT authorization if I intend to engage in training outside of the dates
authorized on my CPT-endorsed I-20, even if the training is with the same employer as a previous authorization.
______ I understand that CPT is approved for a specific employer and position and that I may not change employers or positions
without submitting a new CPT application.
______ I understand that being authorized for more than 364 days of full-time CPT at my current degree-level will result in my
ineligibility for Optional Practical Training (OPT) at my current degree-level and that it is my responsibility to monitor all
full-time CPT authorization dates if I am interested in retaining my eligibility for OPT. I understand that part-time CPT has
no impact on OPT eligibility.
______ I authorize the release of any information necessary for this request and authorize any changes needed to complete my
request.
PartIVa:CPTEmploymentInformation[TOBECOMPLETEDBYTHESTUDENT]
CompanyName PositionTitle
StartDate / / EndDate
/ /
HoursPerWeek:
□ Full‐Time(morethan20hrs/week) □ Part‐Time(20hrsorless/week)
DoyouhaveaSocial
SecurityNumber(SSN)?
□ Yes □ No
IsthisanextensionofapreviousCPTauthorization?
□ Yes □ No
PartVa:AcademicAdvisorRecommendation[TOBECOMPLETEDBYTHEACADEMICADVISOR]
CourseCode&CRN
CourseName
#ofCredits
Termof
Enrollment
□Fall□Winter□Summer
Year
Bysigningbelow,Icertifythatthestudenthassubmittedthenecessarypaperworktobefullyapprovedforanundergraduate
academicinternshipcoursebasedonthejoblistedinPartIVaandthatthestudentisregisteredforthecourselistedabove.
Advisor’sName
Email
@nova.edu
Signature
Date
Phone
3
OptionB:ToBeCompletedOnlyByExELInternshipCPTApplicants
PartIIIb:ConfirmationofUnderstanding
[TOBECOMPLETEDBYTHESTUDENT]
Readandinitialnexttoconfirmyouragreementwitheverystatement.Ifyoudonotunderstandanyofthe
informationspeaktoanInternationalStudentAdvisorbeforeinitialingandsubmittingyourapplication.
Applicationswithoutinitialsnexttoeverystatementwillnotbeaccepted.
______ I confirm that I have been “lawfully enrolled on a full-time basis for one full academic year” at an eligible
institution. I understand that receiving CPT authorization and engaging in CPT without meeting eligibility requirements is
a status violation and may impact future USCIS applications.
______ I understand and confirm that I will not begin training until I have received my new, CPT-authorized I-20. Starting
work before I have received my new, CPT-authorized I-20 is a status violation and cause for termination.
______ I understand CPT will be authorized per the dates on the job offer letter, not to exceed one year and not to start prior to
when I become eligible for CPT (see above).
______ I understand that I must re-apply for additional CPT authorization if I intend to engage in training outside of the dates
authorized on my CPT-endorsed I-20, even if the training is with the same employer as a previous authorization.
______ I understand that CPT is approved for a specific employer and position and that I may not change employers or positions
without submitting a new CPT application.
______ I understand that being authorized for more than 364 days of full-time CPT at my current degree-level will result in my
ineligibility for Optional Practical Training (OPT) at my current degree-level and that it is my responsibility to monitor all
full-time CPT authorization dates if I am interested in retaining my eligibility for OPT. I understand that part-time CPT has
no impact on OPT eligibility.
______ I authorize the release of any information necessary for this request and authorize any changes needed to complete my
request.
PartIVb:CPTEmploymentInformation[TOBECOMPLETEDBYTHESTUDENT]
CompanyName PositionTitle
StartDate / / EndDate
/ /
HoursPerWeek:
□ Full‐Time(morethan20hrs/week) □ Part‐Time(20hrsorless/week)
DoyouhaveaSocial
SecurityNumber(SSN)?
□ Yes □ No
IsthisanextensionofapreviousCPTauthorization?
□ Yes □ No
PartVb:CareerDevelopmentRecommendation[TOBECOMPLETEDBYTHECAREERADVISOR]
Student’sCatalogYear
This option is only available to students under catalog year 2017-18 and beyond.
Bysigningbelow,IcertifythatthestudenthasreceivedapprovaltoparticipateinanExELInternshipforthetrainingexperiencelisted
ontheattachedjobofferletter(tobeprovidedbythestudent)andthatpendingthesuccessfulcompletionofallExELInternship
requirementsthisstudentwillreceiveatleastoneExELunitforthistrainingexperience.
Career
Advisor’sName
Email
@nova.edu
Signature
Date
Phone
4
ToBeCompletedbyAllApplicants
PartVI:ApplicationChecklist&Signature
[TOBECOMPLETEDBYTHESTUDENT]
Pleasecheckeachboxtoensureyouaresubmittingacompletedapplicationpacket:
□ ThiscompletedUndergraduateCPTApplicationPacket
‐Page1–TOBECOMPLETEDBYALLAPPLICANTS
PartI–StudentInformation
PartII–CPTAuthorizationType
‐Page2–TOBECOMPLETEDONLYBYACADEMICCREDITCPTAPPLICANTS
PartIIIa–ConfirmationofUnderstanding
PartIVa–EmploymentInformation
PartVa–AcademicAdvisorRecommendation
‐Page3–TOBECOMPLETEDONLYBYExELINTERNSHIPCPTAPPLICANTS
PartIIIb–ConfirmationofUnderstanding
PartIVb–EmploymentInformation
PartVb–CareerAdvisorRecommendation
‐Page4–TOBECOMPLETEDBYALLAPPLICANTS
SectionVI–ApplicationChecklist&Signature
□ Ajobofferletterwhichiswrittenoncompanyletterheadandincludesthefollowinginformation:
Student’sfullname
Placeofemployment&jobtitle
Beginningandendingdatesofemployment(day,month,andyear)
Numberofhoursofworkperweek
Nameofsupervisor
Descriptionofjobresponsibilitieswhicharedirectlytiedtomymajor
Iconfirmthatalloftheinformationprovidedinthisapplicationisaccuratetothebestofmyknowledge.
Name(print) Signature Date
OIASTAFFUSEONLY:
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Cptug - NSU UG CPT Application

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Completed 2 December 2019

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