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CPT Employer Attestation
Student Information
Student First Name
Student Last Name
Job Description
Student will work full-time when school is not in session. Please see guidelines for full-time permissibility below.
Yes
No
Hours Per Week
1
2
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20
40
Proposed Employment Start Date
*Note that this cannot begin before CPT approval
Proposed Employment Start Date
*Note that this cannot begin before CPT approval
January
February
March
April
May
June
July
August
September
October
November
December
1
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2044
Proposed Employment End Date
*Note that this cannot be after the student graduates and must be no more than 365 days beyond the Employment Start Date
Proposed Employment End Date
*Note that this cannot be after the student graduates and must be no more than 365 days beyond the Employment Start Date
January
February
March
April
May
June
July
August
September
October
November
December
1
2
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2024
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2040
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2043
2044
*Note that for part-time CPT, students are not allowed to exceed 20 hours/week while school is in session. During breaks, however, it is permissible to work more than 20 hours per week. This includes Summer, winter, and spring breaks excluding holidays, snow days, and weekends.
Please email Benjamin Nourse Gross at bgross@longy.edu with any questions.
Employer Contact Information
Full Name
Title
Organization Name (if applicable)
Phone Number
Email Address
Country
Street
City
Region
Postal Code
Employer Description
Please explain who you are, who you work for and in what capacity, the name of the student you’re hiring, why you’re hiring them and what they’ll be doing for you or your organization.
Employer Attestation
I hereby declare that I am offering Curricular Practical Training to the student declared within and am not displacing a citizen or permanent resident of the United States from employment in the process.
Employer E-signature
Electronic Signatures:
I acknowledge and agree this form may be executed by electronic signature, which shall be considered as an original signature for all purposes and shall have the same force and effect as an original signature.
Electronic Signatures:
I acknowledge and agree this form may be executed by electronic signature, which shall be considered as an original signature for all purposes and shall have the same force and effect as an original signature.
Yes
8 CFR 274a.12(b)(6)(iii)
Curricular practical training (internships, cooperative training programs, or work-study programs which are part of an established curriculum) after having been enrolled full-time in a Service approved institution for one full academic year. Curricular practical training (part-time or full-time) is authorized by the Designated School Official on the student's Form I-20. No Service endorsement is necessary.
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