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Form CPT Application Cancel

The document is a Curricular Practical Training Cancellation Form for a student at the University of Northern Virginia. It contains fields for the student's personal information and details about canceling a CPT authorization, including the company name, address, contact person, end date of employment, reason for leaving the job, and a requirement for the employer to provide a job evaluation. It requires the student's signature and date and includes areas for the office to note if an evaluation was received and the submission deadline.

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Vinnu Kumar
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© © All Rights Reserved
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Download as PDF, TXT or read online on Scribd
26 views

Form CPT Application Cancel

The document is a Curricular Practical Training Cancellation Form for a student at the University of Northern Virginia. It contains fields for the student's personal information and details about canceling a CPT authorization, including the company name, address, contact person, end date of employment, reason for leaving the job, and a requirement for the employer to provide a job evaluation. It requires the student's signature and date and includes areas for the office to note if an evaluation was received and the submission deadline.

Uploaded by

Vinnu Kumar
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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University of Northern Virginia

7535 Little River Turnpike, Suite 103, Annandale, Virginia 22003


Phone: (703) 941-0949 Fax: (703) 941-0893-www.unva.edu

Curricular Practical Training Cancellation Form


SEVIS #N

Student ID

Mr. / Mrs. / Ms.


Student Last (Family) Name

Student First Name

M.I.

I would like to cancel the work authorization for:


Company Name:
Company Address:

Company Phone:

Employment to end date is

Name of Company Contact:

Reason for leaving Job:

I understand that the employer will provide a job evaluation with this form
otherwise I will not be eligible for any further CPT work authorization.

Student Signature

Date

For Office Use Only:


Evaluation attached

Yes

No

Date to submit ______________________

Co-Op Assistant Signature _______________________________________Date ___________________________________

Rev. 5/22/08

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