OPT Employment Reporting Form

~This form is to be used by WFU international students currently on a period of post-completion OPT~

First Name:
Last Name:
I am currently:		employed unemployed no longer residing in the U.S.
Reason for submitting this form:		report initial employment (first job on OPT) report change of employer report loss of employment report departure from U.S.
If you are reporting initial employment, provide the date your employment began: (mm/dd/yyyy)
If you are reporting a change of employer, provide:		Date former employment ended: (mm/dd/yyyy) Date new employment began: (mm/dd/yyyy)
If you are reporting a loss of employment, provide the date your employment ended: (mm/dd/yyyy)
If you no longer reside in the U.S., provide the date of your departure: (mm/dd/yyyy)
~Only provide the following information if you are currently employed~
Name of employer:
Address of Employer:

Wake Forest University Center for International Studies P.O. Box 7385 Winston-Salem, NC 27109-7385