OPT Employer Reporting Requirement Form

You must report employer information within 90 days of being approved for OPT. This information is used to update SEVIS and stop the 90 day “clock”. Failure to report this information on time could result in the automatic termination of your status and OPT eligibility. Once submitted, the information is automatically sent to your immigration advisor at Cal Poly Humboldt. You will receive a confirmation email from your Advisor once the information has been processed and your SEVIS record updated.

Any changes to this information should be reported as soon as possible to your immigration advisor. You can report changes by submitting another OPT Employer Reporting Requirement Form. You must also report any changes to your physical address. To update your address, please submit the Address Update form found online here.

Please report the following information:

Student name

Student Humboldt ID number

Student email

Please indicate the purpose of this reporting action

Initial employment

Change in employment

Addition of another employer (working for multiple employers)

End date of last employment

Year

Month

Day

Employer Name & Company Address

Employer's Employment Identification Number (EIN)

Start date (first date of employment)

Year

Month

Day

End date (only if known)

Year

Month

Day

Are you working full time or part time?

Full-time

Part-time

Supervisor's name

Supervisor's email

Statement

Please provide a 2-3 sentence statement explaining how the job you are working is related to the field of study listed on your I-20.

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OPT Employer Reporting Requirement Form