Notre Dame de Namur University
International Programs

Authorization to Enroll in the Cooperative Education Program

Student Name _______________________  Student ID Number__________

Student has been in F-1 status 9 consecutive months:                 ____ Yes   ____  No
Student has completed a minimum of 12 units each quarter:       ____ Yes   ____  No
Student has a grade point average of 2.0 or higher:                      ____ Yes   ____  No

This student has pervious work authorization (enter dates):
From _______ to ______ ;  From ______ to ______; From ______ to ______;
From _______ to ______ ;  From ______ to ______; From ______ to ______;

Dates of proposed employment: From ________ to _________

Number of hours of employment authorized per week:  __ 20 hours or less;  __ more than 20 hours

Student is authorized to enroll in the Internship Program in ___________ semester

__________________________________________________________________
Name and Position of Designated School Official and Title

_______________________________________________________________________________
Signature of Designated School Official                                                     Date

I understand and acknowledge that the signature of the Designated School Official on the form does not authorize me to begin the proposed off-campus employment.  I understand that it would be a violation of immigrations regulations and my F-1 status to begin the proposed employment until I receive written and signed authorization by the Designated School Official for the employment on page 3 of my NDNU I-20.  I understand and acknowledge that if the employment is authorized on my Form I-29 I am authorized to be employment only within the dates and for the number of hours per week stated on the employment authorization on page 3 of my I-20.

I understand and acknowledge that I am authorized to be employed only by the employer stated on page 3 of my Form I-20.  I agree to comply with all of the requirements of the Internship program and understand that failure to comply with all of the requirements could terminate my right to continue the authorized employment and could result in a violation of immigration regulations.

 

___________________________________ ______________________   ___________________

For Office Use Only:  I-20 expiration date;  ____________  Passport expiration date_______