CPT Request Form

CPT Request Form
Before you start your application, please visit the international student page and review the CPT section.

CLICK HERE TO ACCESS INTERNATIONAL STUDENT PAGE
***Submit this form along with required documents to the Office of international Student Services***
Name*

First NameMiddle NameLast NameSuffix
SEVIS ID Number*
UOTP Student ID*
Date of Birth*

MonthDayYear
Date
UOTP Student Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Degree *
(Associate’s, Bachelor’s or Master’s)
Major *
(e.g. Business, Information Technology etc.)
Program Concentration*
Program start date*

MonthDayYear
Date
Program end date**

MonthDayYear
Date
Requested Start Date for CPT*

MonthDayYear
Date
Employer Details:
Company Name:*
Company Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor’s Information:
Student’s Title/Position:*
Supervisor’s Name:*
Student’s Employment Start Date:*

MonthDayYear
Date
End Date, if known:

MonthDayYear
Date
Supervisor’s Title:*
Supervisor’s Email:*
example@example.com
Supervisor’s Phone:*
Please enter a valid phone number.
Offer/Employment letter)*

*PDF file only!!!
Cancelof
Employment:*

Full TimePart Time
Is this CPT a course requirement?*

YesNo
University of the Potomac requires undergraduate and graduate F-1 students to obtain either an internship or gainful employment for at least one semester in their field of study to obtain hands-on knowledge and skills. If you wish to waive the CPT requirement, please contact your Designated School Official.
Which course?*
Why is this CPT opportunity necessary during your time of study?*
Student Signature:*

Clear
Date*

MonthDayYear
Date
Should be Empty: