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California State University, Fullerton

OPT Employer Information

According to U.S. Federal regulations pertaining to F-1 students on Optional Practical Training, F-1 students are responsible and required to report the following information during the entire period of authorized OPT (including paid or unpaid/volunteer OPT work):

  • Current U.S. address
  • Name of OPT Employer
  • Address of OPT Employer

Note: To maintain F-1 status while on approved OPT, you must be working--paid OR unpaid or a combination of paid and unpaid--in a position related to your major, at least 20 hours per week. If you are currently on approved OPT, please complete and submit the form below each time you have a new employer.

Student Information

(no dash)

e.g. N0001234567

Current address





e.g. WAC1012345678

e.g. 657-278-2787

I am currently on approved OPT and my approved OPT dates are:

Returning Home (Giving Up Remainder of Approved OPT)
If you are currently on approved OPT but have decided to return to your home country, please complete this section:

(mm/dd/yyyy) and I will submit a copy of my plane ticket via email attachment or fax to the office of International Programs. I understand that I will not be able to return to the U.S. using my F-1 approved OPT status.


OPT Employer Information (for either paid or unpaid employment)
All F-1 student on approved Optional Practical Training must report their OPT employer information.

Name of organization or company

Employer address:





Eg: 657-278-2787

Employer Information (For second employer, either paid or unpaid)

Name of organization or company

Employer address:





Eg: 657-278-2787

Revised — January 2013