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OPT and STEM Extension Reporting Form
Personal Information
Family Name
First Name(s)
UW Student ID Number
UW Email Address (@wisc.edu only)
Personal Email Address
Telephone Number (123-456-7890)
Passport Expiration Date (MM/DD/YYYY)
I have the following authorization:
OPT
OPT STEM extension
Please select from the options below to fulfill your OPT/STEM reporting requirements.
If you do not remember what you have reported in the past, please use the selections below to submit your information again. You are responsible for submitting your information within 10 days of any change.
Change in legal name in your passport
Change in U.S. home address
Change in foreign address
Change in visa status
Add an employer for the first time
Report a change in employer
Report multiple employers
Report that you are self-employed
Report employment through a staffing or employment agency
Report unemployment
Report a change in your employment/employer information (you work for the same employer, but need to report a change in your employer's name, employer address change, position/responsibility change, material change to I-983 Training Plan, etc.)
STEM: Complete 6-month or 18-month validation report
STEM: Submit 12-month evaluation for form I-983 Training Plan
STEM: Submit 24-month final evaluation for form I-983 Training Plan
You have departed the U.S. and will no longer use your work authorization
Other:
Report preferred email address
Please issue an updated I-20 to reflect my employment
Yes (electronic copy only in Academic Objective documents in Terra Dotta)
No
University of Wisconsin-Madison 702 Landgon Street, Suite 130 Pyle Center iss.wisc.edu 608-262-2044 International Student Services Madison, Wisconsin 53706 iss@iss.wisc.edu
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