By signing below, I agree to the following:
▪ I acknowledge that the student and rotation site information are correct, and that the above
activity is a curricular requirement for the student’s program/degree.
▪ I agree that I will notify the International Student & Scholar Services office with any changes
pertaining to the student’s site information above.
▪ I understand that students who work full time (20-40 hours a week) under CPT become
ineligible for a full 12 months of Optional Practical Training (Part-time CPT does not effect a
student’s eligibility for a full 12-month term of OPT).
▪ I understand that falsified information can result in legal consequences, including termination
of the student’s F-1 immigration status at Loma Linda University.
Print Name (Academic Advisor or Department/Program Chair)
_________________________________________ ________ _________________________
Department Extension Email