Eastern Kentucky University

Office of International Student and Scholar Services

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STEM OPT Extension Request Form

Please review STEM OPT Extension information before completing the application.

Please note, it will take us up to 5 business days to process your application. You will be contacted by email when the I-20 is ready.

PERSONAL INFORMATION

First Name *

Last Name *

Student ID# *

SEVIS ID# *The SEVIS ID# is found on your I-20 and it begins with the letter “N”.

Street Address *

Apartment, suite, etc

City *

State *

ZIP / Postal Code *

Phone Number *

Email Address *

EMPLOYMENT INFORMATION

Explain how this employment is related to your course of study *

Employer Name *

Employer Identification Number (EIN) *Ask your human resources department to obtain the EIN (a nine-digit number).

Your Job Title *

Employment Start Date *

Year

Month

Day

Full Time / Part Time Employment Status *Full Time: more than 20 hours per weekPart Time: 20 or less hours per week

Employer Address *

Apartment, suite, etc

City *

State *

ZIP / Postal Code *

DEGREE PROGRAM INFORMATION

I am applying for 24-month STEM OPT Extension (choose one) *Based on the most recent STEM degree from EKU.Based on previous STEM degree received in the past 10 years from an SEVP-certified school that is accredited.

Major *

Degree Level *Bachelor'sMaster'sDoctoral

Name of Previous SchoolIf your degree was earned at EKU, skip to Supervisor Information section.

Address of Previous School

City

State

ZIP / Postal Code

School Code

CIP Code

Date Degree was awarded

Year

Month

Day

SUPERVISOR INFORMATION

First Name *

Last Name *

Title *

Phone Number *

Email Address *

REQUIRED DOCUMENTS

Please upload these documents in PDF format only.

Completed Form I-983 *

No file chosen