F-1 OPT Address & Employment Change Form




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PLEASE COMPLETE ALL FIELDS WITH AN ASTERISK(*).

PLEASE CHECK AND COMPLETE ANY OTHER INFORMATION THAT
NEEDS CORRECTED IN YOUR SEVIS RECORD.


*YOUR FIRST NAME:
*YOUR LAST NAME:
SEVIS #: (upper right hand corner of I-20)*
*YOUR E-MAIL ADDRESS:
Home Address (Please type in your new home address in the space below). Check this box if this is an address change

WORK STATUS: I am:
currently employed
Type in Employer Name:
Type in Employer Address below:
became unemployed on (MM/DD/YYYY)

EMPLOYMENT HISTORY: Since effective date of OPT, please include any periods of unemployment
Start Date
End Date
Employer Name(if applicable)
Employer Address(if applicable)

Start Date
End Date
Employer Name(if applicable)
Employer Address(if applicable)

Start Date
End Date
Employer Name(if applicable)
Employer Address(if applicable)

Thanks!

For any problems with this form, contact Jane.Scott@utsouthwestern.edu