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Student Completes this Section Student Name: (Please Print) First Middle Last SS : Telephone: E-Mail Address: Major: Previous Periods of Practical Training: Curricular Practical Training Company Name Part-time or Full-time Dates of CPT Dates of Proposed Curricular Practical Training: From to: (Please Notes these Dates must match the Dates on the Employer s offer letter) This training will be: Full Time Part Time (20 hours of work per week or less) (Please indicate the total number of hours per week) Name of Employer: Complete Mailing Address of Employer: Faculty Advisor Completes this Section I anticipate that this student will complete all the requirements for their current program of study on or about: Fall: Winter: Spring: Summer: (Term 1) (Term 2) Please provide a brief explanation on why this particular Curricular Practical Training Experience is Integral to the student s academic program..
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