Fillable Opt Ead/ Address/ Employment Reporting Form printable pdf download

T E A C H E R S C O L L E G E

C O L U M B I A U N I V E R S I T Y

O F F I C E O F I N T E R N A T I O N A L S E R V I C E S

OPT EAD/ ADDRESS/ EMPLOYMENT REPORTING FORM

**You are required to update OIS with any changes in the information below until you are no longer

in F-1 status.

Please print clearly.

Name: _______________________________

SEVIS ID # (from I-20) N000________________

Current preferred email: ________________________________

Current local US address: ___________________________________________

Address 2: ____________________________________________

____________________________________________

City

State

Zip code

Please read the following and check ALL that are applicable. Provide additional information as

requested.

_____ I have received my EAD card. The dates are ___________ (begin date) to ________ (end date).

_____ I have given a copy of my OPT/EAD card to the Office of International Services (or it’s attached).

*If not, bring your EAD to the office or fax us a copy. (Fax #: 212-678-3990)

_____ I am currently employed/have specific job offer. Start date: ___________________

Employer’s Name: _________________________________________

Address 1:

____________________________________________

Address 2:

____________________________________________

City

State

Zip code

______ I have multiple employers. * If you have more than two, please list additional employers on the

back side of this page. Include employers’ names, complete addresses, and start dates.

Primary Employer’s Name and start date:

Additional Employer’s Name and start date:

_________________________ / _________

_______________________ /___________

Address 1:___________________________

Address 2:___________________________

___________________________

City

State

Zip code

City

State

Zip code

_____ I am self-employed. Provide your business address (which can be the same as your personal

address.) Date started self-employed business: _________

Address 1:

____________________________________________

Address 2:

____________________________________________

City

State

Zip code

_____ I am not currently employed. End date of previous employment: _________

(Please note that while on post-completion OPT, students may not be unemployed for a total of

more than 90 days during their OPT year. Up to Ten (10) days between employments does not

count toward 90-day limit.)

_____ I have decided to leave the U.S. and discontinue OPT. I will be departing the U.S. permanently

on _______________ (date). My foreign address is:

Address 1: ___________________________________

Address 2: ___________________________________

Country, postal code: ___________________________________

_____I will discontinue my OPT in order to begin a new academic program on __________ (date).

_____I have obtained a change of status to ____ (e.g. H-1, G-4, etc.) effective on ___________ (date).

I agree for the OIS to act on my request for the above. ____________________________________________________________

Name (Signature)

Date

BOX 308, 525 WEST 120

STREET, NEW YORK, NY 10027-6696 · (212) 678-3939 · FAX (212) 678-3990 · EMAIL

tcintl@tc.edu

WEBSITE

Opt Ead/ Address/ Employment Reporting Form

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