Fillable Printable Curricular Practical Training (CPT) Application - Northwestern University

Curricular Practical Training (CPT) Application - Northwestern University

IO USE ONLY

Date received: ____________

Pick up on : ____________

Advisor initials: ____________

Northwestern University - The International Office

630 Dartmouth Place, Evanston, IL 60208-2147

Ph: (847) 491-5613 - Fax: (847) 556-6006

www.northwestern.edu/international - [email protected]

STUDENT INFORMATION

First Name:

SEVIS ID:

Student ID:

Family Name:

Degree level:

Major:

Minor:

Name of Company/Institution:

Start Date:

End Date:

Full Time (21 hours per week or more) Part Time (20 hours per week or fewer)

NU VERIFICATION

Option 1: Work is needed to fulfill requirements for an established course

Option 2: Work is part of an established co-op, clinical training program or other required training program

If other, list course:

Option 3: Graduate student who is registered for thesis, dissertation, or continuation courses and the work is necessary

for the completion of the thesis, dissertation, or degree.

If other, list course:

ACADEMIC NECESSITY

Identify which class you will be or are registered for that necessitates CPT.

I am requesting:

Curricular Practical

Training (CPT) Application

Updated 05/2013

OFFER INFORMATION - Must match offer letter exactly

Site of Activity (Complete Address):

Name:

Title:

Signature:

Date:

By signing below, I confirm that the above named student is currently enrolled as full-time and is in good academic standing.

If the student indicated 'other' above, please explain how the course indicated and the associated CPT is an integral or required

part of the student's program of study below:

This form is required before any off-campus opportunity can be authorized for CPT. Note: CPT is authorized on a quarter-by-

quarter basis. The student should fill out the top portion and then meet with the appropriate NU individual for his/her signature.

This individual could be either your academic advisor, thesis/dissertation advisor, McCormick Career Office advisor, or Chicago

Field Studies advisor.

1st Quarter/Semester at NU: