STEM Validation Report

STEM-EXTENSION OPT
6 MONTH VALIDATION REPORT

While on your STEM-Extension OPT, the Department of Homeland Security requires that you fill out this report every 6 months from the start date on your STEM-Extension EAD card.

* Indicates a required field

To:
International Programs & Services

From:
* Today’s Date :
* SJSU Student ID # :
* Last/Family Name :
* First/Given Name :
* Current Address :
* e-mail :
* SEVIS ID # :
* Name of Current Employer :
* Employer’s Address :
* Name of Supervisor :
* Employer Phone # :
* Employment Start date :
*Employment End date : Indicate “on-going” if currently employed

Have there been any changes in the above information in the last 6 months? Yes No

If yes, please explain :

Be sure to provide us with a copy of your current STEM-Extension EAD, if you have not done so.

I certify that the above information is true and correct