Curricular Practical Training Academic Verification Packet (Page 2 of 2) in pdf

Curricular Practical Training Academic Verification Packet Page 2

F‐1 Curricular Practical Training (CPT) Academic Verification Form

STUDENT INFORMATION

Student Name:

Student Email:

Degree Program:

Expected completion date:

INTERNSHIP INFORMATION

Employer Name:

Employer Address (street):

(city, state, ZIP):

Dates of Employment:

Number of hours per week:

TO BE COMPLETED BY ACADEMIC ADVISOR OR FACULTY SUPERVISOR

Employment under CPT must be an integral part of an established curriculum and be directly related to the

student’s field of study. Please complete the information below so that we may process this student’s CPT

request. If you have any questions, contact the Immigration Specialist assigned to your school or department

(see for contact information).

Will this curricular practical training experience delay the student's graduation date? Yes____ or No____

Please select the most appropriate option below:

____ This training is required as part of the degree. This requirement is stated in the school’s catalog or in

departmental literature describing the program. The student _____will / _____will not (check one)

receive academic credit based on stated departmental guidelines for the program.

____ This training is a degree option (such as an internship or practicum option). The student will enroll in

____________ (course) and receive academic credit for this training program. The student will receive

_____ credits during ____________ term for this practicum/internship.

____ This training is for the purpose of collecting data essential for completion of the thesis or dissertation.

Please briefly explain below how this training is directly related to the thesis or dissertation

research:

_____________________________________________________________________________________________

Advisor Signature:

Advisor Name (print):

Phone:

E‐mail:

Date:

Updated 06/07/2011

Curricular Practical Training Academic Verification Packet Page 2