The form below is provided for employers who have recently employed a University of Missouri - St. Louis student who has applied for and/or been authorized for the 17-month OPT Extension.

Federal Regulations require employers of STEM Extension students to notify the University of Missouri - St. Louis within 48 hours of an early departure or termination of employment. As per the regulations, 'an employer shall consider a worker to have departed when the employer knows the student has left the employment, or if the student has not reported for work for a period of 5 consecutive business days without the consent of the employer, whichever occurs earlier.' [8CFR 214.2(f)(10)(ii)(C)]

If you have any questions regarding this requirement, please contact the Office of International Student & Scholars at (314) 516-5229 or popec@umsl.edu.


Student Information
First Name
Last Name

Employer Information
Supervisor Name
Supervisor Email
Employer Name
Employer Address 1
Employer Address 2
City State Postal code


I verify that the individual listed above is no longer employed with the company listed in this form as of (enter the last date of employment: mm/dd/yyyy)