PDF NC STATE UNIVERSITY

STEM OPT NEW EMPLOYER FORM

NC STATE UNIVERSITY

Office of International Services

internationalservices.ncsu.edu

320 Daniels Hall, Box 7222 - (phone) 919.515.2961 ois@ncsu.edu - (fax) 919.515.1402

Last Name First Name NC State Email Alternative Email Current Residential Address

Employer's Name Employer's E-Verify Number (if disclosed by employer) Employer Identification Number (EIN)

SECTION I - STUDENT INFORMATION

NC State Student ID SEVIS ID Number Cell Phone Number Program Major STEM OPT EAD End Date (if available) I have not yet received an EAD card for my STEM OPT.

SECTION II - NEW EMPLOYER INFORMATION

Student's Job Title Student's Work Location Address Start Date of Employment

SECTION III - STUDENT CERTIFICATIONS I hereby request OIS to update my STEM OPT employment record in SEVIS and issue a new I-20. I have attached the completed final self-evaluation of my performance for my previous employer (page 5 of Form I-983) signed by myself and my previous employer o( nly needed if the previous employment has ended ). I have attached a copy of my STEM OPT EAD card (if approved ). I have attached a new Form I-983 (pages 1-4) completed and signed by myself and my new employer

My new employer is enrolled in E-Verify and my position with this employer will be paid, at least 20 hours per week and directly related to my program major.

I understand that I am responsible for the STEM OPT reporting requirements during my STEM OPT extension, including the 6-month validation reports, annual and final self-evaluations; I also certify that I have reviewed the STEM Extension Reporting Requirements section of OIS's STEM OPT webpage and checked my STEM OPT reporting windows using OIS's STEM OPT Calculator. I understand that I will be responsible for reporting the end of my employment by updating the end date of employment in the SEVP Portal and submitting a final self-evaluation (page 5 of Form I-983, last section) for the ended employment to OIS within 10 days from the end of employment. I understand that if I accept a job offer from another employer, I will be responsible for reporting my new employment by submitting to OIS a completed Form I-983 for the new employer and 2,6

VNew Employer form within 10 days from the start of employment.

I understand that I will be responsible for reporting any material change that may occur to my STEM OPT training plan by completing and submitting to OIS a modified Form I-983; I also certify that I have reviewed the list of material changes to a STEM OPT training plan on the DHS website and understand that these material changes may include, but are not limited to:

- Any change of the employer's EIN; - Any reduction in student compensation that is not tied to a reduction in hours worked; - Any significant decrease in hours per week that a student engages in a STEM training opportunity; - Changes to the employer's commitments or student's learning objectives as documented on the Form I-983. I have reviewed the STEM OPT Employer Requirements and Responsibilities on the USCIS website and certify that, to the best of my knowledge, my new employment will be based on a bona fide employer-employee relationship. I understand that I am allowed to have a total of up to 150 days of unemployment during the entire OPT period (including both the initial postcompletion OPT and STEM OPT extension) and confirm that I have not exceeded this maximum period of unemployment. I understand that in addition to the STEM OPT reporting requirements mentioned above, I will be responsible for notifying OIS of the following changes: - Change of my residential address (within 10 days of change, by updating "Home/Mailing" and "SEVIS Local" address fields in MyPack); - Change of my legal name or immigration status (e.g. H-1B, F-2, permanent residence, etc); - Departure from the U.S. (by completing and submitting a Departure Form).

Reviewed 05/01/2019

Student's Signature

Date

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