Practice Experience/CPT Application

CPT

Federal regulations state, Curricular Practical Training (CPT) is defined to be an internship, cooperative education, or any other type of required internship or practicum that is offered by sponsoring employers through cooperative agreements with the school. You are required to use this form to request authorization to accept OFF-CAMPUS EMPLOYMENT (paid or unpaid) as it relates to practicums, internships, or practice experience courses. Once the form is submitted it will be reviewed and once approved you will receive a new I-20 showing the employer and the CPT approval. CPT must be authorized each semester. The dates of CPT authorization are limited to align with semester enrollment dates.

When submitting this form, you must list your advisor's e-mail as the reviewer. Once your advisor has approved your form, allow a minimum of 7 working days for a response to your request. All requests for CPT should be discussed with your advisor prior to completing this form.

Family Name

First Name:

Student ID

Program

Select your degree level

List your major track

Examples include: Epidemiology, DPT, TCOM, CRM, etc.

List the CPT Course number

List the course you will be enrolled in that corresponds to your CPT request. This must be a required course that is listed on your degree plan. (example BIOS 5300)

List the proposed begin date of your CPT

month/day/year

Select the type of CPT for which you wish to apply

List the proposed end date of your CPT

month/day/year

What is your proposed program completion date?

This is the last day that you will be enrolled in required courses.

Your CPT employer's company name and address

CPT Employer Letter or Project Agreement

In order to apply for CPT, you must submit either the course project agreement or a job offer letter from your employer on company letterhead, which must include the following information: 1. Your full name 2. Company name and address (physical address, not a P.O. Box) 3. Position title with job description 4. Supervisor's name, phone number, and e-mail address 5. Salary/hourly wage for the position 6. Number of hours per week to be worked 7. Start Date and End Date

Academic Advisor Approval

Insert your academic advisor's e-mail address and this form will be e-mailed to them for their approval. Extension requests will not be considered until your advisor has approved this form. It is advisable to warn your advisor to expect an e-mail from OrgSync regarding this approval request.