OISVS - Address and Work Reporting Form

OISVS Address and Work Reporting Form 21

By submitting this form, you will be reporting your current address and other details to the Office of International Students and Visiting Scholars and ACU to meet the DHS requirements.

Confirmation of Contact Information

Email Address

ACU ID

First Name

Last Name

Please list your residential address. If you are in the dorms or the UP, list your dorm name and room number.

Country

Street

City

Region

Postal Code

Residential address zip code

List your ACU Box number (if you have one)

What's your cell phone number?

Marital Status

Single

Married

Emergency Contact Information

Has your emergency contact information changed?

If your information has changed, select "yes" and list the new information, including name and telephone number of the new emergency contact.

Yes

No

Please list the name and telephone number of the new emergency contact.

Employment Status

Are you currently on post-completion Optional Practical Training or J-1 Academic Training? (post-graduation)

Yes

No

Are you currently employed?

Yes

No, not yet, still looking

No, I'm leaving the U.S. and ending my OPT/AT early.

Please describe how this work relates directly to your major.

What is the name of your employer? (the company name)

What is your employer's EIN number?
(This is only required if you are on STEM OPT.)

Is your employment full-time or part-time?
Part time is defined as 20 hours or less per week.

Full-time

Part-time

What is your position title?

What is your employment start date?

What is your employment end date?

Please list the complete address of your employer.

What is your supervisor's name, email and phone?

_____________________________________________________________________________________

By typing my name below, I certify that the information provided in this form are known to be true and correct to the best of my knowledge.

PLEASE ELECTRONICALLY SIGN BELOW THAT YOU UNDERSTAND THE ABOVE STATEMENTS.

Electronically sign your name below: