Additional Remarks (optional): Provide additional information pertinent to the Plan.
SECTION 6: EMPLOYER OFFICIAL CERTIFICATION
I declare and affirm under penalty of perjury that the statements and information made herein are true and correct to the best of my knowledge,
information and belief. I understand that the law provides severe penalties for knowingly and willfully falsifying or concealing a material fact, or using
any false document in the submission of this form.
Employer Official with Signatory Authority - I certify that:
1. I have reviewed, understand, and will follow this Training Plan for STEM OPT Students (Plan);
2. I will conduct the required periodic evaluations of the student;*
3. I will adhere to all applicable regulatory provisions that govern this program (see 8 CFR Part 214.2(f)(10)(ii)); and
4. I will notify the DSO regarding any material changes to or material deviations from this Plan at the earliest available opportunity, including if I
believe the student is not receiving appropriate training as delineated in this Plan.
Signature of Employer Official with Signatory Authority:
Printed Name and Title of Employer Official with Signatory Authority:
Date (mm-dd-yyyy):
PRIVACY ACT STATEMENT
AUTHORITIES: Section 101(a)(15)(F) of the Immigration and Nationality Act of 1952, as amended (INA), 8 U.S.C. 1101(a)(15)(F), Section 641 of the
Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (IIRIRA), Pub. L. 104-208, Div. C, 110 Stat. 3009-546 (codified at 8 U.S.C.
1372), Section 502 of the Enhanced Border Security and Visa Entry Reform Act of 2002, Pub. L. 107-173, 116 Stat. 543 (codified at 8 U.S.C. 1762)
and Homeland Security Presidential Directive No. 2 (HSPD-2), authorize U.S. Immigration and Customs Enforcement (ICE) to collect the information
requested in this form.
PURPOSE: The information collection on this form is used to assist in the administration of the STEM Optional Practical Training (OPT) extension so
that Designated School Officials (DSO) can properly recommend the Student for and review and help coordinate his or her STEM optional practical
training opportunity.
ROUTINE USES: The information collected on this form may be shared with: the individuals who signed the Plan, relevant DSOs acting as liaisons
with the DHS, Federal, State, local, or foreign government entities for law enforcement purposes, Members of Congress in response to requests on
the Student’s behalf, or as otherwise authorized pursuant to its published Privacy Act system of records notice - Privacy Act of 1974: U.S.
Immigration and Customs Enforcement, DHS/ICE-001 Student and Exchange Visitor Information System (SEVIS) System of Records
(https://www.dhs.gov/system-records-notices-sorns
).
DISCLOSURE: The information you provide is voluntary. However, failure to provide the information requested on this form may delay or prevent
participation in a STEM OPT opportunity.
PAPERWORK REDUCTION ACT
The public reporting burden for this collection of information is estimated to average 7.5 hours per response, including time required for searching
existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final
collection. You do not have to supply this information unless this collection displays a currently valid Office of Management and Budget (OMB) control
number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, send them to: U.S.Immigration and
Customs Enforcement, Office of Policy, 500 12th Street SW, Washington, D.C. 20536
*See evaluation forms that follow for student’s first evaluation, to occur before the one year anniversary of the start date of the student’s STEM OPT
employment authorization, and final program evaluation.