Cap Gap Extension I 20 Application - Stevens Institute Of Technology
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1
2Application for Cap-Gap Extension I-20
International Student & Scholar Services
Please e-mail this form and your I-797 Receipt or Approval Notice from USCIS for the H-1B to
the designated individual listed in the Contact Information for ISSS section of the ISSS
homepage ( ).
Today’s Date: ______/ ______/____________ (mm/dd /yyyy)
I.
STUDENT INFORMATION
Family Name:
Given Name:
Stevens ID:
SEVIS ID:
E-mail Address*:
*We will contact you using this email while you are on the cap-gap extension.
CURRENT COMPANY OR INSTITUTION
II.
Select one of the following if it applies to you:
Unemployed
Contract (1099) Laborer
Self-employed
Name of Company/Employer:
Job Title:
Employment Start Date (mm/dd/yyyy):
Number of Hours Per Week:
Employer’s Mailing Address:
Street:
Suite
Building
Apt
Floor (select one)
Number: ______________
City:
State:
Zip Code:
III.
PHYSICAL LOCATION OF WORK
I am currently working at a location other than my employer’s mailing address:
YES
NO
If yes, please select site type:
Client
Company Branch
Home
Other:_________
Client Name, If applicable:
Physical location address, if you indicated YES above:
Street:
Suite
Building
Apt
Floor (select one)
Number: ______________
City:
State:
Zip Code:
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