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.