Get the free Form to Request Opt Out for Prevention Medication
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An Independent Licensee
of the Blue Cross and
Blue Shield AssociationForm to Request Opt Out for Prevention Medication
If you want to exclude a specific medication from the BCB SAZ prevention medication
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How to fill out form to request opt
How to fill out form to request opt
01
Start by obtaining the form to request OPT from your designated school official.
02
Carefully read and understand the instructions provided with the form.
03
Fill out the personal information section accurately, including your full name, date of birth, and contact details.
04
Provide your SEVIS number and A-number, if applicable.
05
Indicate the requested employment start and end dates.
06
Choose the appropriate reason for requesting OPT and provide any necessary supporting documentation.
07
Include your signature and date in the designated fields.
08
Review the completed form for any errors or omissions.
09
Make a copy of the form for your records.
10
Submit the form to your designated school official for review and processing.
11
Wait for a confirmation from your school official regarding the status of your OPT request.
Who needs form to request opt?
01
International students studying in the United States on an F-1 visa who wish to engage in practical training related to their field of study can use the form to request Optional Practical Training (OPT).
02
Students who are currently enrolled full-time in a SEVP-certified educational institution and have completed at least one academic year are eligible to apply for OPT.
03
It is important to consult with your designated school official to determine if you meet the eligibility requirements and if OPT is appropriate for your academic and career goals.
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