Office of International Student Services♦Liberty University, 1971 University Blvd., Lynchburg, VA 24515
Phone (434) 592-4118♦Fax (434) 582-2969♦mystatus@liberty.edu♦ www.liberty.edu/international
Updated 2/10/2017
Optional Practical Training Reporting Form
for F-1 international Students
Student Information:
Name: Student ID #:
Alternate Email Address:
Current Address:
Home Phone number: Cell Phone Number:
Employer Information (to be filled out by student):
Check if Self-Employed
Name: _______________________________________
Employer Identification Number (Not Required):_______________________
Start Date: _______________ End Date: __________________ Hours per week: _______________
Job Title: ______________________________________________________
Employer Address: __________________________________________________________________________
Supervisor Information:
Last Name, First Name:______________________________________________________________________
Telephone number: _____-______-_______ext.______ Email Address: ______________________________
Explain how employment is related to student’s course of study (Max 1000 characters)
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
It is recommended that you keep evidence of each job: the position held, proof of the duration of that position, the job title,
contact information of your supervisor or manager, and a description of your work. Volunteer work may count as employment
while on OPT. If it is not clear from the job description that the work is related to your degree, it is highly recommended that you
obtain a signed letter from your employer stating how your degree is related to the work performed.
Fill out this form and send it to your International Student Advisor to report any changes while you are on OPT.
What do you need to report?
New employer information (one page per employer)
End of a job
Change of address
