OPT - Student Request for Advisor Approval

International Student Services
Center for Global Education & Engagement
iss@brockport.edu

Student Name Student Name First Last
Banner ID
Must be 9 digits. Currently Entered: 3 digits.
Brockport Email
Current U.S. Address Current U.S. Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Permanent Address in Home Country Permanent Address in Home Country
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Degree Level

Degree Level Bachelor's Master's
Degree Program
Degree Completion Date Degree Completion Date / MM / DD YYYY
Have you participated in CPT or OPT at this degree level before?

Have you participated in CPT or OPT at this degree level before? Yes No
List all of your previous CPT or OPT approvals and the dates that you were approved for them.
Proposed Start Date: Proposed Start Date: / MM / DD YYYY
Proposed End Date: (typically one full year minus 1 day from start date) Proposed End Date: (typically one full year minus 1 day from start date) / MM / DD YYYY
Describe proposed employment. You are required to seek work in your area of study. You may use your program's description on the Brockport website to help articulate the types of jobs and areas of work you would like to pursue. We recommend that you keep the description as general as possible for your area of study.
Maximum of 250 words allowed. Currently Entered: 0 words.
This training will be

This training will be Full time Part time (20 hrs/wk or less)
Your Advisor's Name Your Advisor's Name First Last
Your Advisor's Email