106 Bradley International Hall
417 Charles E. Young Drive West
Los Angeles, CA 90095-1379
310-825-1681
STEM OPT Extension I-20 Request Checklist
Please review the STEM OPT Extension Workshop and prepare materials before scheduling an appointment with F-1
Counselor.
• Reported all post-completion OPT employment in your SEVP Portal account
• Completed STEM OPT Extension I-20 Request Form
• $380 STEM OPT Extension Administrative Processing Fee Payment Receipt
• Completed Form I-983 (See Form I-983 Instructions)
• Copy of your latest I-94 Admission Record
• Copy of your latest Travel History Page
• Copy of passport biographical page (passport must be valid at least 6 months into the future from the date that
USCIS will receive your STEM OPT Extension application)
•
Copy of most recent initial 12-month OPT I-20 (pages 1 & 2 with student’s signature on page 1)
•
Copy of EAD (front and back sides)
•
Copy of your STEM degree diploma or official transcript
•
Employment verification letter
o Letter must be recently dated on official letterhead and include student’s job title, supervisor’s name,
employer’s contact information, and employer’s E-Verify ID)
STEM OPT EXTENSION I-20 REQUEST FORM
Last Name: ___________________________________ First Name: ______________________________________
(as it appears on passport) (as it appears on passport)
UCLA ID#: ____________________________________ SEVIS ID#: N____________________________________
Email: _______________________________________ Phone: ___________________________________________
Date of Birth:_________________________________ EAD Card End Date: ________________________________
Employer Name:__________________________________________________________________________________
Employer E-Verify Number:_________________________________________________________________________
FOR DCISS
USE ONLY
INIT: _____________ DATE: _____________________
□ OPT Admin Fee
□ Restriction Holds and Enrollment
□ Within 90 days