7– month stem opt extension - California State University, Long Beach

Brotman Hall Room 201
1250 Bellflower Blvd, Long Beach, CA 90840
PH 562-985-4106 • FAX 562-985-1725
[email protected]
Center for International Education
International Student Services (ISS)
California State University, Long Beach
7– MONTH STEM OPT EXTENSION
Application Guide for Students with Existing 17-Month STEM OPT EADs
on May 10, 2016
Use this application if:
 You are currently in Active F-1 status in an authorized period of 17-month STEM OPT extension, you have at
least 150 days remaining in your STEM Employment Authorization Document (EAD) and meet all requirements
of the 24-month STEM OPT extension.
Eligibility
You are eligible to apply for additional 7-month STEM OPT extension if you meet the following criteria:
 You are currently in Active F-1 status in in an authorized period of 17-month STEM OPT.

You have at least 150 days of approved STEM OPT left on the day that USCIS receives your Form I-765,
“Application for Employment Authorization.”

You have received a qualifying STEM degree from a school that was both accredited and Student and Exchange
Visitor Program-certified at the time that they applied for a STEM OPT extension. Please visit the department’s
website for the full list of recognized accrediting agencies.
You have not receive STEM OPT extension before for the same degree level.
You must have an employer which is enrolled in and remains in good standing with the E-Verify electronic
eligibility verification program, as determined by U.S. Citizenship and Immigration Services.
You and your employer agree to submit a Form I-983 to ensure that you are receiving the academic and training
benefits of your STEM OPT extension. For more information, visit the Form I-983 resources on the STEM OPT
Hub.



When to Apply
The filing period to request the additional 7-Month STEM OPT extension is May 10, 2016, through August 8, 2016. In
addition, the application must be filed within 60 days of the date the DSO enters the recommendation for the 7-month
STEM OPT extension in your SEVIS record or the application will be denied.
Helpful resources:
Optional Practical Training Extension for STEM Students (STEM OPT)
STEM OPT HUB
How to Apply
Please read the instructions below very carefully. There are 3 Steps to apply for STEM OPT extension:
Step
1
Prepare your 24- MONTH STEM OPT Extension Application Include all of the following documents:
Completed 24-MONTH STEM OPT Extension Request form. Only PDF format will be accepted.
Completed Form G-1145.
Completed Form I-765— Use black ink only and be sure that your signature does not touch the lines.
Complete Form I-983 . The STEM OPT student and their prospective employer must work together to
complete this form prior to the student applying for the STEM OPT extension. Only PDF format will be
accepted. Use the following Information to help you fill out Form I-983:
A. Name of School recommending OPT: California State University Long Beach
B. SEVIS School Code of School Recommending STEM OPT: LOS214F00361000
C. Designated School Official (DSO) information:
Mayra L. Serna-Gallegos
1250 Bellflower Boulevard- MS0109, BH-201
Long Beach, Ca 90840
[email protected]
562-985-4106
A copy of the U.S. Degree.
A job offer letter from an employer that is registered with the E-Verify program.
Photocopies of all your travel and immigration documents:
 Passport Information/Photo page (valid for at least 6 months)
 Copy of Visa
 Current EAD card (front and back)
 I-94 Card (front & back of paper card or electronic print out)
 Your most current SEVIS I-20s
Step
2
Step
3
Submit your Application to the CIE Via email at: [email protected] –
 Remember that your documents must be submitted as a PDF file.
 Allow 7-10 business days to process your request.
 Your DSO will process a new I-20 with the recommendation for the 7-Month STEM OPT.
Pick up your I-20 and the 24-Month STEM OPT Extension Cover Sheet from CIE and mail your
documents to USCIS  You will receive an email when your documents are ready for pick up.


Specific mailing instructions will be provided.
Applications for the 7-Month STEM OPT STEM extension must be received by USCIS on or before
August 8, 2016 and within 60 days of the date the DSO enters the recommendation for the
7-month STEM OPT extension in your SEVIS record or the application will be denied.
Brotman Hall Room 201
1250 Bellflower Blvd, Long Beach, CA 90840
PH 562-985-4106 • FAX 562-985-1725
[email protected]
Center for International Education
International Student Services (ISS)
California State University, Long Beach
STEM OPT EXTENSION
REQUEST FORM
Complete this form to request a 24– month STEM OPT extension. Please complete Section 1 and submit this form, along with your Application
Materials, to the CIE Front Desk. You will be notified via email when your application and I-20 are ready for pick up.
SECTION 1- To be completed by the student.
 POST-COMPLETION OPT
Student ID Number:
Currently in:
Family Name:
First Name:
Email Address:
Phone Number:
Home Address :
City, State, Zip Code:
Current Degree Level:
 BA  BS
 MA
 MS
Is this application based in a prior STEM degree?
 PhD
 Yes  No
 17—MONTH STEM OPT EXT.
Expiration Date on current EAD card:
Qualifying Degree Level:  BA  BS
 MA
 MS
Qualifying STEM degree:
Qualifying STEM MAJOR CIP Code:
Date when Qualifying STEM degree was awarded:
Name of School where STEM degree was awarded :
 PhD
Employment Information- Select one option below:
 Employed
 Multiple short term gigs
 Self-employed/work for hire
 Self-employed business owner
 Employment through the following agency:
Employer Name (Name of the company):
Address:
City and State:
Zip Code:
9 digit Employer’s Identification Number (EIN#):
Job Title:
Start Date:
Number of hours per week you work:
Supervisor’s Name:
Phone #:
Email:
In 1000 characters or less, explain how the employment is related to course work taken while completing your program of study :
SECTION 2
Initial review to be completed by the CIE Front Desk.
SECTION 3
International Student Advisor Approval.
 Application is Complete.
 Employment and Contact information is updated.
 Degree conferral date: _________________________________
 Degree included on the STEM Designated Degree Program List.
 Passport Expiration date: _______________________________
 Employer is E-Verified.
 No outstanding holds.
 Form I-983– Training Plan is complete and valid.
 School where STEM degree war earned is accredited and SEVP certified.
 Application submitted in a timely manner.
Reviewer Initials: ____________
Date Submitted to Advisor:_____________
Date Received Stamp:
The student’s request for OPT STEM extension is
 Accepted
 Rejected
Advisor Signature ____________________________Decision Date___________
STEM OPT Request Form 05/02/2016
1
e-Notification of Application/Petition Acceptance
USCIS
Form G-1145
Department of Homeland Security
U.S. Citizenship and Immigration Services
OMB No. 1615-0109
Expires 09/30/2016
What Is the Purpose of This Form?
Use this form to request an electronic notification (e-Notification) when U.S. Citizenship and Immigration Services accepts your
immigration application. This service is available for applications filed at a USCIS Lockbox facility.
General Information
Complete the information below and clip this form to the first page of your application package. You will receive one e-mail and/or
text message for each form you are filing.
We will send the e-Notification within 24 hours after we accept your application. Domestic customers will receive an e-mail and/or
text message; overseas customers will only receive an e-mail. Undeliverable e-Notifications cannot be resent.
The e-mail or text message will display your receipt number and tell you how to get updated case status information. It will not
include any personal information. The e-Notification does not grant any type of status or benefit; rather it is provided as a convenience
to customers.
USCIS will also mail you a receipt notice (I-797C), which you will receive within 10 days after your application has been accepted;
use this notice as proof of your pending application or petition.
USCIS Privacy Act Statement
AUTHORITIES: The information requested on this form is collected pursuant to section 103(a) of the Immigration and Nationality
Act, as amended INA section 101, et seq.
PURPOSE: The primary purpose for providing the information on this form is to request an electronic notification when USCIS
accepts immigration form. The information you provide will be used to send you a text and/or email message.
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information may prevent
USCIS from providing you a text and/or email message receipting your immigration form.
ROUTINE USES: The information provide on this form will be used by and disclosed to DHS personnel and contractors in
accordance with approved routine uses, as described in the associated published system of records notices [DHS-USCIS-007 Benefits Information System and DHS-USCIS-001 - Alien File (A-File) and Central Index System (CIS), which can be found at
www.dhs.gov/privacy]. The information may also be made available, as appropriate for law enforcement purposes or in the interest
of national security.
Paperwork Reduction Act
An agency may not conduct or sponsor an information collection and a person is not required to respond to a collection of information
unless it displays a currently valid OMB control number. The public reporting burden for this collection of information is estimated at
3 minutes per response, including the time for reviewing instructions and completing and submitting the form. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to:
U.S. Citizenship and Immigration Services, Regulatory Coordination Division, Office of Policy and Strategy, 20 Massachusetts
Avenue, NW, Washington, DC 20529-2140. OMB No. 1615-0109. Do not mail your completed Form G-1145 to this address.
Complete this form and clip it on top of the first page of your immigration form(s).
Applicant/Petitioner Full Last Name
E-mail Address
Form G-1145 09/15/14 Y
Applicant/Petitioner Full First Name
Applicant/Petitioner Full Middle Name
Mobile Phone Number (Text Message)
Page 1 of 1
OMB No. 1615-0040; Expires 02/28/2018
I-765, Application For
Employment Authorization
Department of Homeland Security
U.S. Citizenship and Immigration Services
Action Block
Fee Stamp
For
USCIS
Use
Only
Initial Receipt
Resubmitted
Relocated
Received
Sent
Completed
Application Denied - Failed to establish:
Application Approved
Eligibility under
8 CFR 274a.12
(a) or (c)
Authorization/Extension Valid From
Authorization/Extension Valid To
Economic necessity under
8 CFR 274a.12(c)(14), (18)
and 8 CFR 214.2(f)
Subject to the following conditions:
I am applying for:
1.
Denied
A#
Applicant is filing under section 274a.12
Permission to accept employment.
Replacement (of lost employment authorization document).
Renewal of my permission to accept employment (attach a copy of your previous employment authorization document).
15. Current Immigration Status (Visitor, Student, etc.)
Full Name
(Family Name)
(First Name)
2.
Other Names Used (include Maiden Name)
3.
U.S. Mailing Address
(Street Number and Name)
(State)
4.
Country of Citizenship or Nationality
5.
Place of Birth
(Town or City)
(State/Province)
6.
Date of Birth (mm/dd/yyyy)
7.
Gender
8.
Marital Status
Married
Male
(Middle Name)
16. Eligibility Category. Go to the “Who May File Form I-765?”
section of the Instructions. In the space below, place the letter
and number of the eligibility category you selected from the
instructions. For example, (a)(8), (c)(17)(iii), etc.
(Apt. Number)
(Town or City)
9.
Approved
(ZIP Code)
(Country)
Divorced
C
) (
3
) (
C
)
17. (c)(3)(C) Eligibility Category. If you entered the eligibility
category (c)(3)(C) in Question 16 above, list your degree, your
employer's name as listed in E-Verify, and your employer's
E-Verify Company Identification Number or a valid E-Verify
Client Company Identification Number in the space below.
Degree
Employer's Name as listed in E-Verify
Employer's E-Verify Company Identification Number or a Valid
E-Verify Client Company Identification Number
18. (c)(26) Eligibility Category. If you entered the eligibility
category (c)(26) in Question 16 above, please provide the receipt
number of your H-1B principal spouse's most recent Form I-797
Notice of Approval for Form I-129.
Female
Single
(
Widowed
Social Security Number (Include all numbers you have ever
used, if any)
10. Alien Registration Number (A-Number) or Form I-94 Number
(if any)
11. Have you ever before applied for employment authorization
from USCIS?
Yes (Complete the following questions.)
Which USCIS Office?
Dates
Results (Granted or Denied - attach all documentation)
No (Proceed to Question 12.)
12. Date of Last Entry into the U.S., on or about (mm/dd/yyyy)
Applicant's Signature
I certify, under penalty of perjury, that the foregoing is true and
correct. Furthermore, I authorize the release of any information that
U.S. Citizenship and Immigration Services needs to determine
eligibility for the benefit I am seeking. I have read the “Who May File
Form I-765?” section of the instructions and have identified the
appropriate eligibility category in Question 16.
Signature
Date of Signature (mm/dd/yyyy)
Telephone Number
Signature of Person Preparing Form, If Other Than Applicant
I declare that this document was prepared by me at the request of the
applicant and is based on all information of which I have any
knowledge.
Signature
Date of Signature (mm/dd/yyyy)
13. Place of Last Entry into the U.S.
14. Status at Last Entry (B-2 Visitor, F-1 Student, No Lawful
Status, etc.)
Printed Name
Address
Form I-765 02/13/15 Y
How to fill out Form I-765 for STEM OPT extension
Select: Renewal of
my permission to
accept employment
Make sure you put an
address where you will
be for the next 4 - 5
months. (This address
should be the same as on
your mycsulb account.)
(C) (3) (C)
Degree
Ex. “MS Computer
Science”
I-94 number: the
11-digit on your I-94
E-verify #
should be 6 digits long



Check “yes”
To determine USCIS
office use your I-797
Notice of Actions
from OPT or your
OPT receipt number
Dates- dates your
current EAD card is
valid for.
Information in Q#12 and 13 must match your most
current I-94 record.
**Contact CIE if you find errors in your I-94 record**


Make sure your signature fits only in
the black space provided.
Your signature must not touch the line.
Quick guide to USCIS offices/Service Centers:
Vermont Service Center (VSC): Receipt Numbers start with EAC
Nebraska Service Center (NSC): Receipt numbers start with LIN
Texas Service Center (TSC): Receipts start with SRC
California Service Center (CSC): Receipt starts with WAC
Potomac Service Center (PSC): Receipt starts with YSC
04/25/2016