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International Student Services (Century College)

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International Student Services
Curricular Practical Training (CPT) Site Approval Form
Updated 11/14/19
century.edu | 651.779.3300
3300 Century Avenue North, White Bear Lake, MN
55110
Part 1. To Be Completed by the Student: Please Type or Print Clearly
Student Name: ________________________________________________________________________________
Student ID: ______________________ Phone:__________________ Email_______________________________
Part 2. To Be Completed by the Practical Training/Internship Site:
Name of Site/Employer: ________________________________________________________________________
Address of Site/Employer: _______________________________________________________________________
Dates of Practical Training/Internship: ____/____/_____ to ____/____/_____
Hours per week the student will participate in internship/training at your site:
□ 1-20 hours (part-time) □ 21-40 hours
Position Title: _________________________________________________________________________________
Job Responsibilities: ___________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Is this a paid position?
□ Yes □ No
If yes, please attach the offer letter.
By signing below, I indicate that the above information is true based on my best knowledge and information.
________________________________________________________________________________________
Practical Training Site Supervisor Signature Date
________________________________________________________________________________________
Supervisor Name (please print) Phone
Students must make an appointment to meet with an International Student Advisor to review completed CPT forms
and request CPT in SEVIS at least 10 business days prior to starting practical training. Contact International
Student Services with any questions at 651-779-3344, international@century.edu
or Room W1221.
Century College is a member of Minnesota State. We are an affirmative action, equal opportunity employer and educator. This document can be
available in alternative formats to individuals with disabilities by calling 651.773.1745 or emailing access.center@century.edu.
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International Student Services (Century College)

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Completed 26 July 2020

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