urricular practical training (pt) application revised
TRANSCRIPT
Curricular Practical Training (CPT) Application Revised
6/20
Family/Last Name: First Name:
USC ID Number: SEVIS Number: N00
First Sem/Yr at USC: Date of Birth:
Telephone Number: Degree Objective: Bach Master PhD _____________ Other:
Field of Study: Current Status: F-1 J-1 _____________ Other:
Expected Grad Sem/Yr: Email Address:
Local U.S. Address:
Application Instructions 1. Complete application—Missing information will cause processing delays
Academic Advisor’s signature required in section F (see page 2) 2. Register for internship course (if applicable) 3. Enroll in a full course load or submit RCL for Final Semester (if applicable)
Select one: New CPT application Update needed on existing CPT authorization
A. CPT Employer Information This information must match the information on your offer letter.
Company Name:
Company Address:
(PO Box not accepted) Street Number and Street Name Suite # City State Zip Code
Is this your physical work location? Yes. Skip to section C. No. Complete section B
B. Physical Site of Activity Complete if your site of activity is different from the company name indicated above.
Company Name:
Company Address:
(PO Box not accepted) Street Number and Street Name Suite # City State Zip Code
D. Social Security Number (SSN) Letter
I need a letter for my SSN application. Required: SSA requires the original CPT I-20 and SSN letter. Both documents will be sent to you via eShipGlobal (express mail). My eShipGlobal order number: ____________________
I do NOT need a letter because I already have an SSN. I understand that an SS card is not employment authorization and that I must wait until I receive my CPT I-20 from OIS to begin working legally in the US.
C. Dates and Hours of Internship All dates must be in the future.
Start Date: End Date: Number of hours per week:
Will you have a RA/TA/on-campus job as well? hrs/week. Yes. I will work ___ No
. . RCL: __. Restrictions: units for__Office use: ________ ______ ________ ______
Please continue to page 2
Curricular Practical Training (CPT)—continued Revised
6/20
Curricular Practical Training (CPT) is a type of work authorization that allows F-1 international students to participate in paid, off-campus academic internships during their degree program. The purpose of CPT is academic and is not just for employment purposes; therefore, the internship must be considered an integral part of a student’s degree pro-gram. Please review the student’s offer letter to determine if the internship is related to student’s major. If so, please complete the information below and provide D-clearance (if applicable) for enrollment in the appropriate internship course.
Student’s Family/Last Name: ____________________________ First Name: _____________________________
Student has registered for a full course of study in classes that meet degree requirements during fall andspring semesters.
The student intends to pursue practical training in _____________________ which is required for the degree in that: semester/year
the student will participate in an internship program which is a degree requirement for the followingacademic program (select one):
the student is registered in ________________ for _____________________ and is required to workinternship course semester/year
off-campus to fulfill course requirements.
Comments:______________________________________________________________________________________
_______________________________________________________________________________________________
Academic Advisor / Internship Coordinator Signature
Academic Advisor / Internship Coordinator Name (please print)
Ext. Date
Office of International Services
F. Academic Advisor’s Verification To Be Completed by Academic Advisor
Cinematic Arts: Peter Stark Program Price: Urban and Regional Planning
Keck: Physical Therapy Price: Health Administration
Ostrow: Advanced Pediatric Dentistry Price: Public Administration
E. CPT History List all previously authorized CPTs. Use separate sheet of paper if additional space is needed.
From (mm/dd/year) To (mm/dd/year) Full-Time or Part Time Grade Received (P/NP, CR/NC, Letter Grade)
1
2
3
I understand that successful completion of the internship course is required to be eligible for current and future CPTauthorizations.