OPT Reporting Form

This form is designed for UMMS sponsored F-1 visa holders on Post-Completion Optional Practical Training (OPT) to report changes in employer information and local or international address while on OPT.   Please remember that changes in U.S. address, international address or OPT employer must be submitted within 10 days following the change to maintain F-1 status.

 PLEASE COMPLETE ALL FIELDS IN RED:

 *Family Name (as on your passport):  
 

 *Given Name(s)
 

 *SEVIS ID
 

 *I am reporting (select one):        

 Other Remarks
 


 *Current U.S. Address (Write "None" and your date of departure from
 the U.S. if your OPT has ended):
 

 *International Address:

  

 

 *Mailing Address for UPS delivery:

 

 

 *Phone Number (for UPS Delivery):     

 

 

 *Non UMMS email address:       

 *Confirm Non UMMS email address:  

  

 

 New OPT Employer Name (If applicable):

 


 OPT Employer Address:
 


 Date of Hire:   

 

 

 Name of Previous OPT Employer (if applicable):
 


 Address of Previous OPT Employer:
 


 Employment End Date (if applicable) (Your last date of employment NOT
 the expiration date of your EAD card.): 

 

 Date of Departure from the U.S. (if applicable): 

 

 Date of Change of Status (if applicable):    

 

 Please include additional information in the Notes section of this
 document if you have been approved a change of status or
 adjustment of status.  Include new status and Receipt number for
 application/petition).  Please forward a copy of your approval
 notice,  I-94 document, permanent resident card, etc., 
 documenting new status to Kate Amaral  
 at kate.amaral@umassmed.edu


 Additional Notes or special instructions: