OPT Employer and Student Information
Please complete and submit this form

Personal Information


SEVIS Number:

Student Family Name:

Student First Name:

Street Address:

Street Address Line 2:

City:

State:

Zip Code:

Non-WKU Email:


Employer Information


Employer Name:

Employer Address:

Address Line 2:

City:

State:

Zip Code:

Other Comments: