Toyota Technological Institute at Chicago
Request for Work Authorization
Authorization Requested
Last (Family) Name First (Given) Name
Work Authorization Start Date
Work Authorization End Date
Full Time or Part time
(part time is 20 hrs or less per week)
Below I am listing all previous periods of authorized employment for OPT and CPT, with exact dates
and degree level for each:
By signing this form I affirm that the employment in which I will engage has direct relevance to my
course of study.
Date
Your name here will be recorded as your signature:
F-1 CPT Ext.
F-1 CPT
F-1 OPT
F-1 OPT STEM Ext.
Full Time
Part Time
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