J-1 Student On-Campus Employment Authorization Request

Date: 5/23/2013

*Required Filed

*	Last Name
*	First Name
*	Email Address

Employment Information

*	Name of Your Employer
		(name of department, office or organization that employs you)
*	Nature of Your Work
		(e.g. GA, TA, RA, adjunct instructor, bus driver, server, cashier, student assistant, etc)
*	Employment Start Date
		(MM/DD/YYYY)
*	Employment End Date
		(MM/DD/YYYY)

Information

REMEMBER: An authorization letter has a maximum validity of 12 months. If your employment contines beyond the validity date of this letter, you will need to request a new letter by completing another form. If you are working for more than one on-campus employer, please click the 'Additional Employment' button to sumbit the details