STEM OPT Training Plan Compliance Checklist

Student Full Name

First NameLast Name

Student Email Address

example@example.com

Employer Name

Employer Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Supervisor Name

Supervisor Email Address

example@example.com

Training Start Date

Date

Training End Date

Date

Have all required evaluations (initial, midpoint, final) been completed and submitted on time?

Compliance Checklist

Other (please specify)

Describe any issues or concerns regarding the STEM OPT training plan compliance.