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ICE Form I-983 (7/16) Page 1 of 5

DEPARTMENT OF HOMELAND SECURITY

U.S. Immigration and Customs Enforcement

TRAINING PLAN FOR STEM OPT STUDENTS

Science, Technology, Engineering & Mathematics (STEM) Optional Practical Training (OPT)

OMB APPROVAL NO. 1653-0054

EXPIRATION DATE: 03-31-2019

SECTION 1: STUDENT INFORMATION (Completed by Student)

Student Name (Surname/Primary Name, Given Name): Student Email Address:

Name of School Recommending

STEM OPT:

Name of School Where STEM

Degree Was Earned:

SEVIS School Code of School Recommending STEM OPT (including 3-

digit suffix):

Designated School Official (DSO) Name and Contact Information: Student SEVIS ID No.: STEM OPT Requested Period (mm-dd-yyyy):

From:

Qualifying Major and Classification of Instructional Programs (CIP) Code:

Level/Type of Qualifying Degree:

Date Awarded (mm-dd-yyyy):

Based on Prior Degree? Yes No

Employment Authorization Number:

1. I have reviewed,understand,and will adhere to this Training Plan for STEM OPT Students (“Plan”);

2. I will notify the DSO at the earliest available opportunity if I believe that my employer is not providing me with appropriate training as

delineated on this Plan;

3. I understand that the Department of Homeland Security (DHS) may deny, revoke, or terminate the STEM OPT of students whom DHS

determines are not engaging in OPT in compliance with the law, including the STEM OPT of students who are not, or whose employers are

not, complying with this Plan;

4. My practical training opportunity is directly related to the STEM degree that qualifies me for the STEM OPT extension; and

5. I will notify the DSO at the earliest available opportunity regarding any material changes to or deviations from this Plan, including but not

limited to, any change of Employer Identification Number resulting from a corporate restructuring, any nontrivial reduction in compensation

from the amount previously submitted on the Plan that is not tied to a reduction in hours worked, any significant decrease in hours per week

that I engage in a STEM training opportunity, and any decrease in hours below the 20-hours-per-week minimum required under this rule.

To:

SECTION 2: STUDENT CERTIFICATION

I declare and affirm under penalty of perjury that the statements and information made herein are true and correct to the best of my knowledge,

information and belief. I understand that the law provides severe penalties for knowingly and willfully falsifying or concealing a material fact, or using

any false document in the submission of this form.

Signature of Student:

Date (mm-dd-yyyy):

I certify that:

Printed Name of Student:

University of West

Georgia

Brandy Rivera brivera@westga.edu

1601 Maple Street, Carrollton, GA 30118

University of West

Georgia

ATL214F00247000

SECTION 3: EMPLOYER INFORMATION (Completed by Employer)

A. Salary Amount and Frequency:

B. Other Compensation (Type and Estimated Amount or Value):

Start Date of Employment (mm-dd-yyyy):

SECTION 4: EMPLOYER CERTIFICATION

I declare and affirm under penalty of perjury that the statements and information made herein are true and correct to the best of my knowledge,

information and belief. I understand that the law provides severe penalties for knowingly and willfully falsifying or concealing a material fact, or using

any false document in the submission of this form.

I certify on behalf of the employer that this Training Plan for STEM OPT Students (“Plan”) is approved and that:

1. I have reviewed and understand this Plan, and I will ensure that the supervising Official follows this Plan;

2. I will notify the DSO at the earliest available opportunity regarding any material changes to this Plan, including but not limited to, any change of

Employer Identification Number resulting from a corporate restructuring, any reduction in compensation from the amount previously submitted

on the Plan that is not tied to a reduction in hours worked, any significant decrease in hours per week that a student engages in a STEM

training opportunity, and any decrease in hours below the 20-hours-per-week minimum required under this rule;

3. Within five business days of the termination or departure of the student during the authorized period of OPT, I will report such termination or

departure to the DSO (Note: business days do not include federal holidays or weekend days; and an employer shall consider a student to have

departed when the employer knows the student has left the practical training opportunity, or when the student has not reported for practical

training for a period of five consecutive business days without the consent of the employer); and

4. I will adhere to all applicable regulatory provisions that govern this program (see 8 CFR Part 214), which include, but are not limited to, the

following:

a. The student’s practical training opportunity is directly related to the STEM degree that qualifies the student for the STEM OPT extension,

and the position offered to the student achieves the objectives of his or her participation in this training program;

b. The student will receive on-site supervision and training, consistent with this Plan, by experienced and knowledgeable staff;

c. The employer has sufficient resources and personnel to provide the specified training program set forth in this Plan, and the employer is

prepared to implement that program, including at the location(s) identified in this Plan;

d. The student on a STEM OPT extension will not replace a full- or part-time, temporary or permanent U.S. worker. The terms and conditions

of the STEM practical training opportunity—including duties, hours, and compensation—are commensurate with the terms and conditions

applicable to the employer’s similarly situated U.S. workers or, if the employer does not employ and has not recently employed more than

two similarly situated U.S. workers in the area of employment, the terms and conditions of other similarly situated U.S. workers in the area

of employment; and

e. The training conducted pursuant to this Plan complies with all applicable Federal and State requirements relating to employment.

Note: DHS may, at its discretion, conduct a site visit of the employer to ensure that program requirements are being met, including that the

employer possesses and maintains the ability and resources to provide structured and guided work-based learning experiences

consistent with this Plan.

Employer Name: Street Address:

North American Industry Classification System (NAICS) Code:

Employer Website URL: City:

Employer ID Number (EIN):

OPT Hours Per Week (must be at least 20

hours/week):

State: ZIP Code:

Suite:

Number of Full-Time

Employees in U.S.:

Compensation:

Signature of Employer Official with Signatory Authority:

Printed Name and Title of Employer Official with Signatory Authority:

Printed Name of Employing Organization:

Date (mm-dd-yyyy):

ICE Form I-983 (7/16) Page 2 of 5

SECTION 5: TRAINING PLAN FOR STEM OPT STUDENTS (Completed by Student and Employer)

EMPLOYER SITE INFORMATION

Note: for the remaining fields in this section, employers who already have an internal/pre-existing training plan in place may fill in the

details based on that plan.

Student Role: Describe the student's role with the employer and how that role is directly related to enhancing the student's knowledge obtained

through his or her qualifying STEM degree.

Goals and Objectives: Describe how the assignment(s) with the employer will help the student achieve his or her specific objectives for work-based

learning related to his or her STEM degree. The description must both specify the student's goals regarding specific knowledge, skills, or techniques

as well as the means by which they will be achieved.

Employer Oversight: Explain how the employer provides oversight and supervision of individuals filling positions such as that being filled by the

named F-1 student. If the employer has a training program or related policy in place that controls such oversight and supervision, please describe.

Measures and Assessments: Explain how the employer measures and confirms whether individuals filling positions such as that being filled by the

named F-1 student are acquiring new knowledge and skills. If the employer has a training program or related policy in place that controls such

measures and assessments, please describe.

Official's Email:

Name of Official:

Official's Phone Number:

Official's Title:

Site Address (Street, City, State, ZIP):Site Name:

Employer Name:

Student Name (Surname/Primary Name, Given Name):

ICE Form I-983 (7/16) Page 3 of 5

Additional Remarks (optional): Provide additional information pertinent to the Plan.

SECTION 6: EMPLOYER OFFICIAL CERTIFICATION

I declare and affirm under penalty of perjury that the statements and information made herein are true and correct to the best of my knowledge,

information and belief. I understand that the law provides severe penalties for knowingly and willfully falsifying or concealing a material fact, or using

any false document in the submission of this form.

Employer Official with Signatory Authority - I certify that:

1. I have reviewed, understand, and will follow this Training Plan for STEM OPT Students (Plan);

2. I will conduct the required periodic evaluations of the student;*

3. I will adhere to all applicable regulatory provisions that govern this program (see 8 CFR Part 214.2(f)(10)(ii)); and

4. I will notify the DSO regarding any material changes to or material deviations from this Plan at the earliest available opportunity, including if I

believe the student is not receiving appropriate training as delineated in this Plan.

Signature of Employer Official with Signatory Authority:

Printed Name and Title of Employer Official with Signatory Authority:

PRIVACY ACT STATEMENT

AUTHORITIES: Section 101(a)(15)(F) of the Immigration and Nationality Act of 1952, as amended (INA), 8 U.S.C. 1101(a)(15)(F), Section 641 of the

Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (IIRIRA), Pub. L. 104-208, Div. C, 110 Stat. 3009-546 (codified at 8 U.S.C.

1372), Section 502 of the Enhanced Border Security and Visa Entry Reform Act of 2002, Pub. L. 107-173, 116 Stat. 543 (codified at 8 U.S.C. 1762)

and Homeland Security Presidential Directive No. 2 (HSPD-2), authorize U.S. Immigration and Customs Enforcement (ICE) to collect the information

requested in this form.

PURPOSE: The information collection on this form is used to assist in the administration of the STEM Optional Practical Training (OPT) extension so

that Designated School Officials (DSO) can properly recommend the Student for and review and help coordinate his or her STEM optional practical

training opportunity.

ROUTINE USES: The information collected on this form may be shared with: the individuals who signed the Plan, relevant DSOs acting as liaisons

with the DHS, Federal, State, local, or foreign government entities for law enforcement purposes, Members of Congress in response to requests on

the Student’s behalf, or as otherwise authorized pursuant to its published Privacy Act system of records notice - Privacy Act of 1974: U.S.

Immigration and Customs Enforcement, DHS/ICE-001 Student and Exchange Visitor Information System (SEVIS) System of Records

(https://www.dhs.gov/system-records-notices-sorns

DISCLOSURE: The information you provide is voluntary. However, failure to provide the information requested on this form may delay or prevent

participation in a STEM OPT opportunity.

PAPERWORK REDUCTION ACT

The public reporting burden for this collection of information is estimated to average 7.5 hours per response, including time required for searching

existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final

collection. You do not have to supply this information unless this collection displays a currently valid Office of Management and Budget (OMB) control

number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, send them to: U.S.Immigration and

Customs Enforcement, Office of Policy, 500 12th Street SW, Washington, D.C. 20536

*See evaluation forms that follow for student’s first evaluation, to occur before the one year anniversary of the start date of the student’s STEM OPT

employment authorization, and final program evaluation.

Date (mm-dd-yyyy):

ICE Form I-983 (7/16) Page 4 of 5

FINAL EVALUATION ON STUDENT PROGRESS

EVALUATION ON STUDENT PROGRESS

Provide a self-evaluation of your performance, using the measures previously identified, in applying and acquiring new knowledge, skills, and

competencies identified in the Training Plan for STEM OPT Students. Discuss accomplishments, successful projects, overall contributions, etc.,

during this review period. Address whether there are any modifications to the objectives and goals for projects, or new areas for skill and competency

development.

Provide a self-evaluation of your performance, using the measures previously identified, in applying and acquiring new knowledge, skills, and

competencies identified in the Training Plan for STEM OPT Students. Discuss accomplishments, successful projects, overall contributions, etc.,

during this review period. Address whether there are any modifications to the objectives and goals for projects, or new areas for skill and competency

development.

Signature of Employer Official with Signatory Authority:

Printed Name of Employer Official with Signatory Authority:

Range of Evaluation Dates: From (mm-dd-yyyy): To (mm-dd-yyyy):

Date (mm-dd-yyyy):

Signature of Student:

Date (mm-dd-yyyy):Printed Name of Student:

Signature of Employer Official with Signatory Authority:

Printed Name of Employer Official with Signatory Authority:

Range of Evaluation Dates: From (mm-dd-yyyy): To (mm-dd-yyyy):

Date (mm-dd-yyyy):

Signature of Student:

Date (mm-dd-yyyy):Printed Name of Student:

ICE Form I-983 (7/16) Page 5 of 5

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