UW-Parkside International Student Services
900 Wood Road
Kenosha, WI 53144 USA
karin.basken@uwp.edu
____________________________________
Gender:
Curricular Practical Training Application (CPT)
University of Wisconsin-Parkside
Please return this form to:
UW-Parkside International Student Services
900 Wood Road
Kenosha, WI 53144 USA
karin.basken@uwp.edu
Be at Parkside.
To be Completed by Student
Participation in and authorization of CPT can only occur BEFORE degree completion
SECTION TO BE COMPLETED BY ISS STAFF ONLY
Name: ___________________________________
SOLAR ID#: _ _ _ _ _ _ _ _ _
Student Signature: ________________________________________
Email: _____________________________ Daytime Phone#: _________________________
Visa type: _______________ (as indicated on current I-94)
Male
(Last) (First)
*If your passport is within 6 months of expiry, renew it as soon as possible.
**For undergraduate or course-work-only Master’s candidates, the completion date is the date of your last exam
or graduation date; for Master’s students with thesis, it is the date on the library deposit
Female
Passport Expiration Date*: ___________________
Major(s): ___________________________________ Degree Level: ________________________________
Expected completion date**: ____________________ (Month/day/year)
If you are applying for “required” CPT, a copy of the departmental requirement showing that all degree
candidates must complete the internship or practical training program.
Completed Academic Advisor Form (included).
Completed Employer Form (included) or employer’s oer letter which covers the same information
requested on form.
Date: _____________________________
ISS Sta Member Confirm:
Visa Status.
Passport Validity
F-1 eligibility (9 months)
Dept. verification of academic internship option
Date reviewed: _______________________________ By: _____________________________________
All attachments indicated are [ ] attached.
If not, return to applicant for resubmission when complete.
ISS MUST RECEIVE THE FOLLOWING DOCUMENTS
Be at Parkside.
UW-Parkside International Student Services
900 Wood Road
Kenosha, WI 53144 USA
karin.basken@uwp.edu
University of Wisconsin-Parkside CPT Application Form - Page 2
TO BE COMPLETED BY THE ACADEMIC ADVISOR
Student Name: ___________________________________________________________________________
(Last) (First)
Student qualifies* for Curricular Practical Training (CPT) based on (indicate one):
An academic internship is required of all students in this program in order to graduate.
☐ An academic internship is an elective option for this program and the department has a specific course
Work experience gained from this internship is integral to the student’s thesis or dissertation and the
student is registered for the appropriate thesis/dissertation research course.
*One of the above qualifiers must be met in order for CPT to be authorized. Please note, if CPT cannot be authorized based
on lack of appropriate qualifier, the student does have another option for work permission in his/her field. This type of work
does not require paperwork by the academic advisor or employer; refer the student to International Student Services.
Academic Department: ____________________________________________________________________
Student is registering for course#: ______________________ and student will earn __________credits for CPT.
Number of hours student will work per week: _______________________
Full Time Part Time
or
The department ___ does or ___ does not consider registering for this course a full-time academic load.
Student’s CPT will occur during the Fall, Spring, or Summer of ______________.
year
Employment to begin on ____________ and end on _____________.
(Dates from advisor and employer need to match.)
_________________________________________________________________________________________________________
Advisor Name Signature Date
E-mail: __________________________________ Phone: _______________________
designed for this purpose.
Be at Parkside.
UW-Parkside International Student Services
900 Wood Road
Kenosha, WI 53144 USA
karin.basken@uwp.edu
University of Wisconsin-Parkside CPT Application Form - Page 3
TO BE COMPLETED BY EMPLOYER
Note to Employer: Please complete this form and submit a letter of oer on company letterhead containing all
the information requested below.
Name: _________________________________________________________________________________
(Last) (First)
Name of Company: _______________________________________________________________________
Company Address: ________________________________________________________________________
________________________________________________________________________
Name of Contact Person: ___________________________________________________________________
E-mail: _______________________________________ Phone: _______________________________
Employment to begin on ____________ and end on _____________.
Number of hours student will work per week: _________
Full Time or Part Time
Paid or Unpaid
Position Title: ____________________________________________________________________________
Brief Position Description (can be attached):
_________________________________________________________________________________________________________
Employer Signature Date
Please return this completed form and attached position description to the student. Student will submit to
International Student Services.
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome