1 CmpletingtheFrmI983 TRAININGPLANFORSTEMOPTSTUDENTS Science, Technlgy, Engineering & Mathematics (STEM) Optinal Practical Training (OPT) STEMOPTstudentsandtheiremplyersaresubjecttthetermsftheFrmI983,TrainingPlanfr STEMOPTStudents,effectiveasfthestartdaterequestedfrSTEMOPTntheFrmI983. Sectin1:StudentInfrmatin(CmpletedbyStudent): StudentName:Enteryurfullname(Surname/PrimaryName,GivenName)exactlyasit appearsnyursevis(studentandexchangevisitrinfrmatinsystem)issuedfrmi20, CertificatefEligibilityfrNnimmigrant(F1)StudentStatus FrAcademicand LanguageStudents. StudentEmailAddress:Entertheemailaddresswhereyucanbecntacted. NamefSchlRecmmendingSTEMOPT:Enterthenamefyurschlfmstrecent enrllment,frmwhichthedesignatedschlofficial(dso)willberecmmendingstem OPT. NamefSchlWhereSTEMDegreeWasEarned:Enterthenameftheschlfrmwhich yuearnedthedegreeupnwhichthestemoptisbased.thismayrmayntbethe sameschlrecmmendingthestemoptifyuareusingaprirstemdegree. SEVISSchlCdefSchlRecmmendingSTEMOPT:EntertheSEVISSchlcdefthe schlrecmmendingthestemopt(includingthe3digitsuffix).thiswuldbeyur currentschlrschlfmstrecentenrllment. DSONameandCntactInfrmatin:Enterthefullnameandcntactinfrmatin,including fficialaddress,phne,andemail,fthedsowhisrecmmendingthisstemoptand prcessedthisfrmi983. StudentSEVISIDNumber:EnteryurSEVISidentificatin(ID)number. STEMOPTRequestedPerid:Entertheperidduringwhichyuarerequestingtwrkn STEMOPT(regardlessfwhethertheauthrizeddatesmatchactualtrainingdates).Nte thatthestemoptextensinmayntendmrethan24mnthsafterthescheduled terminatinfthestudent semplymentauthrizatindcumentfrthecurrentperidf pstcmpletinopt.frastudentn12mnthoptrequestingastemoptextensin, thestartdateshuldbethedayafteryurcurrent12mnthoptends.frastudentn 17mnthSTEMOPTrequestingcnversintthetermsandcnditinsfa24mnth STEMOPTextensin,theF1studentandthestudent semplyerwillbesubjecttthe termsandcnditinsfthefrmi983, TrainingPlanfrSTEMOPTStudents, asfthe datefreceiptatu.s.citizenshipandimmigratinservices(uscis)andthustherequested peridshuldidentifyastartdatenrbefreprperfilingatuscis. QualifyingMajrandClassificatinfInstructinalPrgrams(CIP)Cde:EnteryurSTEM majrthatqualifiesyufrthestemoptextensin,aswellasthedegree s(cip)cde.yu canfindcipcdesnthenatinalcenterfreducatinstatisticswebsiteat:
2 http://nces.ed.gv/ipeds/cipcde/default.aspx?y=55rtheicewebsiteat http://www.ice.gv/sevis. Level/TypefQualifyingDegree:EntertheacademiclevelupnwhichyuarebasingSTEM OPT.(Frexample,enterBachelr s,master s,rph.d.) DateAwarded:Enterthedatewhenthedegree,upnwhichSTEMOPTwillbebased,was awarded. BasednPrirDegree?Check Yes ifyurstemoptparticipatinisbasedna previuslybtainedstemdegree,andisntthesamedegreeupnwhichyurcurrent pstcmpletinoptwasgranted.check N ifyurstemoptparticipatinisbasedn yurmstrecentlybtaineddegree,andthatisthedegreeupnwhichyurcurrentpst cmpletinoptisbased. EmplymentAuthrizatinNumber:Enteryur A number,(whichmaybefundnthe EmplymentAuthrizatinDcument). Sectin2:StudentCertificatin: StudentCertificatin:Reviewthecertificatinandaffirmthestatementbysignature. Sectin3:EmplyerInfrmatin(CmpletedbyEmplyer): EmplyerName:Enteryurcmpany,university,etc.name. StreetAddress,Suite,City,State,ZipCde:Entertheemplyerrcmpanymailingaddress. EmplyerWebsiteURL:EntertheemplyerwebsiteURL,ifavailable.Ifnwebsiteexists, entern/a. EmplyerIDNumber(EIN):EntertheEmplyerIdentificatinNumber(EIN). NumberfFullTimeEmplyeesintheUnitedStates:Prvidethenumberffulltime emplyeesintheunitedstates. NrthAmericanIndustryClassificatinSystem(NAICS)Cde:Enterthecmpany snaics cde.(federalstatisticalagenciesusethenaicscdetclassifybusinessestablishmentsfr thepurpsefcllecting,analyzingandpublishingstatisticaldatarelatedttheu.s. businessecnmy.)naicscdesareaccessibleathttp://www.census.gv/cgi bin/sssd/naics/naicsrch?chart=2012. OPTTrainingHursPerWeek:Entertheagreedupnnumberfaveragetraininghursper week.inrdertqualifyfrstemopt,thestudentmustwrkaminimumf20hursper week. StartDatefEmplyment:EnterthedatewhenthestudentwillbegintheSTEMOPT trainingwiththeemplyer. Cmpensatin:Enterthedllaramuntfsalary,stipend,and/rthercmpensatin,and thefrequencyfpay(perhur,perweek,biweekly,mnthly).othercmpensatinmay includehusing,tuitinwaivers,transprtatincsts,etc.nte:thetermsandcnditins fastempracticaltrainingpprtunity(includingduties,hurs,andcmpensatin)must becmmensuratewiththseapplicabletsimilarlysituatedu.s.wrkers,exceptthata STEMOPTparticipantmustwrkatleast20hursperweekwhileemplyed. Sectin4:EmplyerCertificatin:
3 EmplyerCertificatin:TheEmplyerOfficialwithSignatryAuthrity,whisan apprpriateindividualintheemplyer srganizatin,whisfamiliarwiththestudent s galsandperfrmance,andwhisanemplyeewhhassignatryauthrityfrthe emplyershuldreviewthecertificatinandaffirmthestatementbysignature. NtefrEmplyerOfficialwithSignatryAuthrity:TheEmplyerOfficialwithSignatry AuthrityattestatinincludesthecertificatinatSectin4(d)whichstates Thestudentn astemoptextensinwillntreplaceafullrparttime,tempraryrpermanentu.s. wrker.thetermsandcnditinsfthestempracticaltrainingpprtunity including duties,hurs,andcmpensatin arecmmensuratewiththetermsandcnditins applicablettheemplyer ssimilarlysituatedu.s.wrkersr,iftheemplyerdesnt emplyandhasntrecentlyemplyedmrethantwsimilarlysituatedu.s.wrkersinthe areafemplyment,thetermsandcnditinsfthersimilarlysituatedu.s.wrkersinthe areafemplyment. Sectin5:TrainingPlanfrSTEMOPTStudents (CmpletedbyEmplyer): Inrdertbetterensuretheacademicbenefitandintegrityftheextensin,Federal regulatinsrequireeachstemoptstudenttprepareandexecutewithhisrherprspective emplyerafrmaltrainingplanthatidentifieslearningbjectivesandaplanfrachievingthse bjectives.thestemoptstudentandhisrheremplyermustwrktgethertfinalizethe plan. StudentName:Enterthestudent sname(surname/primaryname,givenname)exactlyas itappearsnthestudent ssevisissuedfrmi20, CertificatefEligibilityfr Nnimmigrant(F1)StudentStatus FrAcademicandLanguageStudents. EmplyerName:Entertheemplyer sname,asitappearsin Sectin3:Emplyer Infrmatin. SiteName:Entertheemplyer ssitename,whichmaybethesameasemplyernamein Sectin3.Hwever,ifthestudentiswrkingfrabranchrsubsidiaryfalargeentity,r anywheretherthantheheadquarters,prvidethenamefthiswrksite. SiteAddress:EntertheexactaddressfthewrksitewheretheSTEMpracticaltrainingwill takeplace. NamefOfficial:Enterthenameftheapprpriateindividualintheemplyer s rganizatinwhisfamiliarwith,andwillmnitr,thestudent sgalsandperfrmance. ThismayrmayntbethesameEmplyerOfficialasinSectin4. Official stitle:enterthetitleftheapprpriateindividualintheemplyer srganizatin whisfamiliarwith,andwillmnitr,thestudent sgalsandperfrmance. Official semail:entertheemailaddressftheapprpriateindividualintheemplyer s rganizatinwhisfamiliarwith,andwillmnitr,thestudent sgalsandperfrmance. Official sphnenumber:enterthephnenumberftheapprpriateindividualinthe emplyer srganizatinwhisfamiliarwith,andwillmnitr,thestudent sgalsand perfrmance. StudentRleandtheTrainingPrgram sdirectrelatinshiptthestudent squalifying STEMDegree:Describewhattasksandassignmentsthestudentwillcarryutduringthe trainingandhwtheserelatetthestudent sstemdegree.theplanmustcveraspecific spanftime,anddetailspecificgalsandbjectives.
4 GalsandObjectives:Describethespecificskills,knwledge,andtechniquesthestudent willlearnrapply;hwthestudentwillachievethegalssetutfrhisrhertraining;and thetrainingcurriculumincludingthetimeline. EmplyerOversight:Explainhwtheemplyerprvidesversightandsupervisinf individualsfillingpsitinssuchasthatbeingfilledbythenamedf1student.ifthe emplyerhasatrainingprgramrrelatedplicyinplacethatcntrlssuchversightand supervisin,adescriptinfthisprgramrplicymaysufficetanswerthequestin. MeasuresandAssessments:Explainhwtheemplyermeasuresandcnfirmswhether individualsfillingpsitinssuchasthatbeingfilledbythenamedf1studentareacquiring newknwledgeandskills.iftheemplyerhasatrainingprgramrrelatedplicyinplace thatcntrlssuchmeasuresandassessments,adescriptinfthisprgramrplicymay sufficetanswerthequestin. AdditinalRemarks.Prvideanyadditinalpertinentinfrmatin. Sectin6:EmplyerOfficialCertificatin: CertificatinfOfficialwithSignatryAuthrity:Nte:Theindividualwhsignsthis Certificatinneedntbe,butcanbe,thesameindividualwhsignedtheEmplyer CertificatininSectin4.Anemplyeewithsignatryauthrityfrtheemplyershuld reviewthecertificatinandaffirmthestatementbysignature.onthematerialchange certificatin(#4),pleasentethatmaterialchangesintheplancaninclude(butarent limitedt)thefllwing:anychangefemplyeridentificatinnumberresultingfrma crpraterestructuring,anyreductinincmpensatinfrmtheamuntpreviusly submittednthefrmi983, TrainingPlanfrSTEMOPTStudents, thatisnttiedta reductininhurswrked,anysignificantdecreaseinhursperweekthatastudent engagesinastemtrainingpprtunity,andanydecreaseinhursbelwthe20hursper weekminimumrequiredunderthisrule. EvaluatinnStudentPrgress: Studentevaluatinsareasharedrespnsibilityfbththestudentandtheemplyert ensurethatthestudent spracticaltraininggalsarebeingsatisfactrilymet.thestudentis respnsiblefrcnductingaselfevaluatinbasednhisrherwntrainingprgress.the emplyermustreviewandsigntheselfevaluatintattesttitsaccuracy. Thestudentsubmitsthefirstassessmentwithintwelvemnthsandafinalevaluatinthat recapsallthetrainingandknwledgeacquiredduringthecmpletetrainingperid. Entertherangefthestudentevaluatindates(thetimelinefrwhichthisevaluatinis relevant). Thestudentmustsign,printname,andenterdatefsignature. TheEmplyerOfficialwithSignatryAuthritymustsign,printname,andenterthedatef signaturetshwcncurrencewiththeassessmentinfrmatinthatthestudenthas entered.
DEPARTMENT OF HOMELAND SECURITY U.S. Immigratin and Custms Enfrcement OMB APPROVAL NO. 1653-0054 EXPIRATION DATE: 03-31-2019 TRAINING PLAN FOR STEM OPT STUDENTS Science, Technlgy, Engineering & Mathematics (STEM) Optinal Practical Training (OPT) SECTION 1: STUDENT INFORMATION (Cmpleted by Student) Student Name (Surname/Primary Name, Given Name): Student Email Address: Name f Schl Recmmending STEM OPT: Name f Schl Where STEM Degree Was Earned: SEVIS Schl Cde f Schl Recmmending STEM OPT (including 3- digit suffix): Designated Schl Official (DSO) Name and Cntact Infrmatin: Student SEVIS ID N.: STEM OPT Requested Perid (mm-dd-yyyy): Frm: T: Qualifying Majr and Classificatin f Instructinal Prgrams (CIP) Cde: Level/Type f Qualifying Degree: Date Awarded (mm-dd-yyyy): Based n Prir Degree? Yes N Emplyment Authrizatin Number: SECTION 2: STUDENT CERTIFICATION I declare and affirm under penalty f perjury that the statements and infrmatin made herein are true and crrect t the best f my knwledge, infrmatin and belief. I understand that the law prvides severe penalties fr knwingly and willfully falsifying r cncealing a material fact, r using any false dcument in the submissin f this frm. I certify that: 1. I have reviewed,understand,and will adhere t this Training Plan fr STEM OPT Students ( Plan ); 2. I will ntify the DSO at the earliest available pprtunity if I believe that my emplyer is nt prviding me with apprpriate training as delineated n this Plan; 3. I understand that the Department f Hmeland Security (DHS) may deny, revke, r terminate the STEM OPT f students whm DHS determines are nt engaging in OPT in cmpliance with the law, including the STEM OPT f students wh are nt, r whse emplyers are nt, cmplying with this Plan; 4. My practical training pprtunity is directly related t the STEM degree that qualifies me fr the STEM OPT extensin; and 5. I will ntify the DSO at the earliest available pprtunity regarding any material changes t r deviatins frm this Plan, including but nt limited t, any change f Emplyer Identificatin Number resulting frm a crprate restructuring, any nntrivial reductin in cmpensatin frm the amunt previusly submitted n the Plan that is nt tied t a reductin in hurs wrked, any significant decrease in hurs per week that I engage in a STEM training pprtunity, and any decrease in hurs belw the 20-hurs-per-week minimum required under this rule. Signature f Student: Printed Name f Student: ICE Frm I-983 (7/16) Page 1 f 5
SECTION 3: EMPLOYER INFORMATION (Cmpleted by Emplyer) Emplyer Name: Street Address: Suite: Emplyer Website URL: City: State: ZIP Cde: Emplyer ID Number (EIN): Number f Full-Time Emplyees in U.S.: Nrth American Industry Classificatin System (NAICS) Cde: OPT Hurs Per Week (must be at least 20 hurs/week): Start Date f Emplyment (mm-dd-yyyy): Cmpensatin: A. Salary Amunt and Frequency: B. Other Cmpensatin (Type and Estimated Amunt r Value): 1. 2. 3. 4. SECTION 4: EMPLOYER CERTIFICATION I declare and affirm under penalty f perjury that the statements and infrmatin made herein are true and crrect t the best f my knwledge, infrmatin and belief. I understand that the law prvides severe penalties fr knwingly and willfully falsifying r cncealing a material fact, r using any false dcument in the submissin f this frm. I certify n behalf f the emplyer that this Training Plan fr STEM OPT Students ( Plan ) is apprved and that: 1. I have reviewed and understand this Plan, and I will ensure that the supervising Official fllws this Plan; 2. I will ntify the DSO at the earliest available pprtunity regarding any material changes t this Plan, including but nt limited t, any change f Emplyer Identificatin Number resulting frm a crprate restructuring, any reductin in cmpensatin frm the amunt previusly submitted n the Plan that is nt tied t a reductin in hurs wrked, any significant decrease in hurs per week that a student engages in a STEM training pprtunity, and any decrease in hurs belw the 20-hurs-per-week minimum required under this rule; 3. Within five business days f the terminatin r departure f the student during the authrized perid f OPT, I will reprt such terminatin r departure t the DSO (Nte: business days d nt include federal hlidays r weekend days; and an emplyer shall cnsider a student t have departed when the emplyer knws the student has left the practical training pprtunity, r when the student has nt reprted fr practical training fr a perid f five cnsecutive business days withut the cnsent f the emplyer); and 4. I will adhere t all applicable regulatry prvisins that gvern this prgram (see 8 CFR Part 214), which include, but are nt limited t, the fllwing: a. The student s practical training pprtunity is directly related t the STEM degree that qualifies the student fr the STEM OPT extensin, and the psitin ffered t the student achieves the bjectives f his r her participatin in this training prgram; b. The student will receive n-site supervisin and training, cnsistent with this Plan, by experienced and knwledgeable staff; c. The emplyer has sufficient resurces and persnnel t prvide the specified training prgram set frth in this Plan, and the emplyer is prepared t implement that prgram, including at the lcatin(s) identified in this Plan; d. The student n a STEM OPT extensin will nt replace a full- r part-time, temprary r permanent U.S. wrker. The terms and cnditins f the STEM practical training pprtunity including duties, hurs, and cmpensatin are cmmensurate with the terms and cnditins applicable t the emplyer s similarly situated U.S. wrkers r, if the emplyer des nt emply and has nt recently emplyed mre than tw similarly situated U.S. wrkers in the area f emplyment, the terms and cnditins f ther similarly situated U.S. wrkers in the area f emplyment; and e. The training cnducted pursuant t this Plan cmplies with all applicable Federal and State requirements relating t emplyment. Nte: DHS may, at its discretin, cnduct a site visit f the emplyer t ensure that prgram requirements are being met, including that the emplyer pssesses and maintains the ability and resurces t prvide structured and guided wrk-based learning experiences cnsistent with this Plan. Signature f Emplyer Official with Signatry Authrity: Printed Name and Title f Emplyer Official with Signatry Authrity: Printed Name f Emplying Organizatin: ICE Frm I-983 (7/16) Page 2 f 5
SECTION 5: TRAINING PLAN FOR STEM OPT STUDENTS (Cmpleted by Student and Emplyer) Student Name (Surname/Primary Name, Given Name): Emplyer Name: Site Name: EMPLOYER SITE INFORMATION Site Address (Street, City, State, ZIP): Name f Official: Official's Title: Official's Email: Official's Phne Number: Nte: fr the remaining fields in this sectin, emplyers wh already have an internal/pre-existing training plan in place may fill in the details based n that plan. Student Rle: Describe the student's rle with the emplyer and hw that rle is directly related t enhancing the student's knwledge btained thrugh his r her qualifying STEM degree. Gals and Objectives: Describe hw the assignment(s) with the emplyer will help the student achieve his r her specific bjectives fr wrk-based learning related t his r her STEM degree. The descriptin must bth specify the student's gals regarding specific knwledge, skills, r techniques as well as the means by which they will be achieved. Emplyer Oversight: Explain hw the emplyer prvides versight and supervisin f individuals filling psitins such as that being filled by the named F-1 student. If the emplyer has a training prgram r related plicy in place that cntrls such versight and supervisin, please describe. Measures and Assessments: Explain hw the emplyer measures and cnfirms whether individuals filling psitins such as that being filled by the named F-1 student are acquiring new knwledge and skills. If the emplyer has a training prgram r related plicy in place that cntrls such measures and assessments, please describe. ICE Frm I-983 (7/16) Page 3 f 5
Additinal Remarks (ptinal): Prvide additinal infrmatin pertinent t the Plan. SECTION 6: EMPLOYER OFFICIAL CERTIFICATION I declare and affirm under penalty f perjury that the statements and infrmatin made herein are true and crrect t the best f my knwledge, infrmatin and belief. I understand that the law prvides severe penalties fr knwingly and willfully falsifying r cncealing a material fact, r using any false dcument in the submissin f this frm. Emplyer Official with Signatry Authrity - I certify that: 1. I have reviewed, understand, and will fllw this Training Plan fr STEM OPT Students (Plan); 2. I will cnduct the required peridic evaluatins f the student;* 3. I will adhere t all applicable regulatry prvisins that gvern this prgram (see 8 CFR Part 214.2(f)(10)(ii)); and 4. I will ntify the DSO regarding any material changes t r material deviatins frm this Plan at the earliest available pprtunity, including if I believe the student is nt receiving apprpriate training as delineated in this Plan. Signature f Emplyer Official with Signatry Authrity: Printed Name and Title f Emplyer Official with Signatry Authrity: PRIVACY ACT STATEMENT AUTHORITIES: Sectin 101(a)(15)(F) f the Immigratin and Natinality Act f 1952, as amended (INA), 8 U.S.C. 1101(a)(15)(F), Sectin 641 f the Illegal Immigratin Refrm and Immigrant Respnsibility Act f 1996 (IIRIRA), Pub. L. 104-208, Div. C, 110 Stat. 3009-546 (cdified at 8 U.S.C. 1372), Sectin 502 f the Enhanced Brder Security and Visa Entry Refrm Act f 2002, Pub. L. 107-173, 116 Stat. 543 (cdified at 8 U.S.C. 1762) and Hmeland Security Presidential Directive N. 2 (HSPD-2), authrize U.S. Immigratin and Custms Enfrcement (ICE) t cllect the infrmatin requested in this frm. PURPOSE: The infrmatin cllectin n this frm is used t assist in the administratin f the STEM Optinal Practical Training (OPT) extensin s that Designated Schl Officials (DSO) can prperly recmmend the Student fr and review and help crdinate his r her STEM ptinal practical training pprtunity. ROUTINE USES: The infrmatin cllected n this frm may be shared with: the individuals wh signed the Plan, relevant DSOs acting as liaisns with the DHS, Federal, State, lcal, r freign gvernment entities fr law enfrcement purpses, Members f Cngress in respnse t requests n the Student s behalf, r as therwise authrized pursuant t its published Privacy Act system f recrds ntice - Privacy Act f 1974: U.S. Immigratin and Custms Enfrcement, DHS/ICE-001 Student and Exchange Visitr Infrmatin System (SEVIS) System f Recrds (https://www.dhs.gv/system-recrds-ntices-srns). DISCLOSURE: The infrmatin yu prvide is vluntary. Hwever, failure t prvide the infrmatin requested n this frm may delay r prevent participatin in a STEM OPT pprtunity. PAPERWORK REDUCTION ACT The public reprting burden fr this cllectin f infrmatin is estimated t average 7.5 hurs per respnse, including time required fr searching existing data surces, gathering the necessary dcumentatin, prviding the infrmatin and/r dcuments required, and reviewing the final cllectin. Yu d nt have t supply this infrmatin unless this cllectin displays a currently valid Office f Management and Budget (OMB) cntrl number. If yu have cmments n the accuracy f this burden estimate and/r recmmendatins fr reducing it, send them t: U.S.Immigratin and Custms Enfrcement, Office f Plicy, 500 12th Street SW, Washingtn, D.C. 20536 *See evaluatin frms that fllw fr student s first evaluatin, t ccur befre the ne year anniversary f the start date f the student s STEM OPT emplyment authrizatin, and final prgram evaluatin. ICE Frm I-983 (7/16) Page 4 f 5
EVALUATION ON STUDENT PROGRESS Prvide a self-evaluatin f yur perfrmance, using the measures previusly identified, in applying and acquiring new knwledge, skills, and cmpetencies identified in the Training Plan fr STEM OPT Students. Discuss accmplishments, successful prjects, verall cntributins, etc., during this review perid. Address whether there are any mdificatins t the bjectives and gals fr prjects, r new areas fr skill and cmpetency develpment. Range f Evaluatin Dates: Frm (mm-dd-yyyy): T (mm-dd-yyyy): Signature f Student: Printed Name f Student: Signature f Emplyer Official with Signatry Authrity: Printed Name f Emplyer Official with Signatry Authrity: FINAL EVALUATION ON STUDENT PROGRESS Prvide a self-evaluatin f yur perfrmance, using the measures previusly identified, in applying and acquiring new knwledge, skills, and cmpetencies identified in the Training Plan fr STEM OPT Students. Discuss accmplishments, successful prjects, verall cntributins, etc., during this review perid. Address whether there are any mdificatins t the bjectives and gals fr prjects, r new areas fr skill and cmpetency develpment. Range f Evaluatin Dates: Frm (mm-dd-yyyy): T (mm-dd-yyyy): Signature f Student: Printed Name f Student: Signature f Emplyer Official with Signatry Authrity: Printed Name f Emplyer Official with Signatry Authrity: ICE Frm I-983 (7/16) Page 5 f 5