Form I-539 Application To Extend/Change Nonimmigrant Status

USCIS
Form I-539

Application to Extend/Change Nonimmigrant Status
Department of Homeland Security
U.S. Citizenship and Immigration Services

OMB No. 1615-0003
Expires 11/30/2021

Action Block

Fee Stamp

For USCIS Use Only
Returned
Resubmitted
Received
Relocated
Sent
Remarks:
Granted

Denied

New Class

Still within period of stay

From

/

/

/

S/D to:

/

Place under docket control

Dates:
To

To be completed by an
Attorney or Accredited
Representative (if any).

/

/

Select this box if
Form G-28 is
attached.

Attorney State Bar Number
(if applicable)

Applicant interviewed on
Attorney or Accredited Representative
USCIS Online Account Number (if any)

► START HERE - Type or print in black ink.

Part 1. Information About You

U.S. Physical Address

Your Full Name

5.a. Street Number
and Name

1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)

5.b.

1.c. Middle Name

5.d. State

Apt.

Ste.

Flr.

5.c. City or Town

2.

Alien Registration Number (A-Number) (if any)
► A-

3.

USCIS Online Account Number (if any)
►

5.e. ZIP Code

Other Information About You
6.

Country of Birth

7.

Country of Citizenship or Nationality

8.

Date of Birth (mm/dd/yyyy)

9.

U.S. Social Security Number (if any)
►

10.

Date of Last Arrival Into the United States (mm/dd/yyyy)

U.S. Mailing Address
4.a. In Care Of Name (if any)

4.b. Street Number
and Name
4.c.

Apt.

Ste.

Flr.

4.d. City or Town
4.e. State

4.f.

Provide Information About Your Most Recent Entry Into the
United States

ZIP Code
(USPS ZIP Code Lookup)

Form I-539 Edition 03/10/21 E

11.

Form I-94 Arrival-Departure Record Number
►

12.

Passport Number

Page 1 of 7

2.b. If you answered "Yes" to Item Number 2.a., provide
USCIS Receipt Number.
►

Part 1. Information about You (continued)
13.

Travel Document Number

3.a. Is this application based on a separate petition or application
to provide your spouse, child, or parent an extension or
change of status?
Yes, filed with this Form I-539.
No

14.a. Country of Passport or Travel Document Issuance

14.b. Passport or Travel Document Expiration Date
(mm/dd/yyyy)

Yes, filed previously and pending with U.S.
Citizenship and Immigration Services (USCIS).

15.a. Current Nonimmigrant Status (e.g. F-1 student, H-4
dependent, etc.)

3.b. If pending with USCIS, provide USCIS Receipt Number.
►

15.b. Expiration Date (mm/dd/yyyy)

If the petition or application is pending with USCIS, also
provide the following information:

16.

4.

First and Last Name of Petitioner or Applicant

5.

Date Filed (mm/dd/yyyy)

Select this box if you were granted Duration of Status
(D/S).

Part 2. Application Type
I am applying for (select only one box):

Part 4. Additional Information About the
Applicant

1.

Reinstatement to student status.

2.

An extension of stay in my current status.

3.a.

A change of status.

Provide Your Current Passport Information (if different from
Part 1.)

3.b. New status and effective date of change (mm/dd/yyyy)

1.a. Passport Number
1.b. Country of Passport Issuance

3.c. The change of status I am requesting is:
1.c. Passport Expiration Date (mm/dd/yyyy)
Number of people included in this application (select only one
box):
4.

I am the only applicant.

Physical Address Abroad

5.a.

Members of my family are filing this application with
me.

2.a. Street Number
and Name

5.b. The total number of people (including me) in the
application is: (Complete the supplement for each coapplicant.)

2.b.

Apt.

Ste.

Flr.

2.c. City or Town
2.d. Province

Part 3. Processing Information
1.

I/We request that my/our current or requested status be
extended until (mm/dd/yyyy):

2.a. Is this application based on an extension or change of
status already granted to your spouse, child, or parent?
Yes

Form I-539 Edition 03/10/21 E

No

2.e. Postal Code
2.f.

Country

Answer the following questions. If you answer “Yes” to any of
the questions in Item Numbers 3. - 15., use the space provided
in Part 8. Additional Information to provide an explanation.

Page 2 of 7

10.

Part 4. Additional Information About the
Applicant (continued)
3.

Are you, or any other person included on the application,
an applicant for an immigrant visa?
Yes
No

4.

Has an immigrant petition EVER been filed for you or for
any other person included in this application?
Yes
No

5.

Has Form I-485, Application to Register Permanent
Residence or Adjust Status, EVER been filed by you or
by any other person included in this application?
Yes

6.

Yes
11.

Have you, or any other person included on the application,
EVER ordered, incited, called for, committed, assisted, helped
with, or otherwise participated in any of the following:
7.a. Acts involving torture or genocide?

Yes

No

7.b. Killing any person?

Yes

No

7.e. Limiting or denying any person's ability to exercise
religious beliefs?
Yes
No
Have you, or any other person included on the application,
EVER:
8.a. Served in, been a member of, assisted, or participated in any
military unit, paramilitary unit, police unit, self-defense unit,
vigilante unit, rebel group, guerrilla group, militia, insurgent
organization, or any other armed group?
Yes
No

8.b. Worked, volunteered, or otherwise served in any prison,
jail, prison camp, detention facility, labor camp, or any
other situation that involved detaining persons?
Yes
9.

No

No

13.

Are you, or any other person included in this application,
now in removal proceedings?
Yes
No

If you answered "Yes" to Item Number 13., provide the
following information concerning the removal proceedings in
the space provided in Part 8. Additional Information. Include
the name of the person in removal proceedings and information
on jurisdiction, date proceedings began, and status of
proceedings.
14.

No

7.d. Engaging in any kind of sexual contact or relations with
any person who did not consent or was unable to consent,
or was being forced or threatened?
Yes
No

Have you, or any other person included in this
application, EVER received any type of military,
paramilitary, or weapons training?
Yes

Have you, or any other person included in this
application, done anything that violated the terms of the
nonimmigrant status you now hold?
Yes
No

7.c. Intentionally and severely injuring any person?
Yes

No

12.

No

Have you, or any other person included in this application,
EVER been arrested or convicted of any criminal offense
since last entering the United States?
Yes
No

Have you, or any other person included in this
application, EVER assisted or participated in selling,
providing, or transporting weapons to any person who, to
your knowledge, used them against another person?

Have you, or any other person included in this
application, been employed in the United States since last
admitted or granted an extension or change of status?
Yes

No

If you answered "No" to Item Number 14., fully describe how
you are supporting yourself in Part 8. Additional Information.
Include documentary evidence of the source, amount, and basis
for any income.
If you answered "Yes" to Item Number 14., fully describe the
employment in Part 8. Additional Information. Include the
name of the person employed, name and address of the
employer, weekly income, and whether the employment was
specifically authorized by USCIS.
15.

Are you, or any other person included in this application,
currently or have you ever been a J-1 exchange visitor or
a J-2 dependent of a J-1 exchange visitor?
Yes

No

If you answered "Yes" to Item Number 15., you must provide
the dates you maintained status as a J-1 exchange visitor or J-2
dependent in Part 8. Additional Information.

Have you, or any other person included in this application,
EVER been a member of, assisted, or participated in any
group, unit, or organization of any kind in which you or
other persons used any type of weapon against any person
or threatened to do so?
Yes
No

Form I-539 Edition 03/10/21 E

Page 3 of 7

I understand that USCIS will require me to appear for an
appointment to take my biometrics (fingerprints, photograph,
and/or signature) and, at that time, I will be required to sign an
oath reaffirming that:

Part 5. Applicant's Statement, Contact
Information, Declaration, Certification and
Signature
NOTE: Read the Penalties section of the Form I-539
Instructions before completing this section.

1) I reviewed and understood all of the information
contained in, and submitted with, my application; and
2) All of this information was complete, true, and correct
at the time of filing.

Applicant's Statement
NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2.
1.a.

I can read and understand English, and I have read
and understand every question and instruction on this
application and my answer to every question.

1.b.

The interpreter named in Part 6. read to me every
question and instruction on this application and my
answer to every question in

I certify, under penalty of perjury, that all of the information in
my application and any document submitted with it were
provided or authorized by me, that I reviewed and understand
all of the information contained in, and submitted with, my
application and that all of this information is complete, true, and
correct.

Applicant's Signature
,

6.a. Applicant's Signature

a language in which I am fluent, and I understood
everything.
2.

6.b. Date of Signature (mm/dd/yyyy)

At my request, the preparer named in Part 7.,

,
prepared this application for me based only upon
information I provided or authorized.

Applicant's Contact Information
3.

Applicant's Daytime Telephone Number

NOTE TO ALL APPLICANTS: If you do not completely fill
out this application or fail to submit required documents listed
in the Instructions, USCIS may deny your application.

Part 6. Interpreter's Contact Information,
Statement, Certification, and Signature
Provide the following information about the interpreter.

4.

Applicant's Mobile Telephone Number (if any)

Interpreter's Full Name
5.

Applicant's Email Address (if any)

1.a. Interpreter's Family Name (Last Name)

1.b. Interpreter's Given Name (First Name)

Applicant's Declaration and Certification
Copies of any documents I have submitted are exact
photocopies of unaltered, original documents, and I understand
that USCIS may require that I submit original documents to
USCIS at a later date. Furthermore, I authorize the release of
any information from any and all of my records that USCIS
may need to determine my eligibility for the immigration
benefit that I seek.

2.

Interpreter's Business or Organization Name (if any)

I furthermore authorize release of information contained in this
application, in supporting documents, and in my USCIS
records, to other entities and persons where necessary for the
administration and enforcement of U.S. immigration law.

Form I-539 Edition 03/10/21 E

Page 4 of 7

Part 6. Interpreter's Contact Information,
Statement, Certification, and Signature
(continued)

Part 7. Contact Information, Declaration, and
Signature of the Person Preparing this
Application, if Other Than the Applicant

Interpreter's Mailing Address

Provide the following information about the preparer.

3.a. Street Number
and Name

Preparer's Full Name

3.b.

Apt.

Ste.

Flr.

1.a. Preparer's Family Name (Last Name)

3.c. City or Town
1.b. Preparer's Given Name (First Name)
3.d. State
3.f.

3.e. ZIP Code

Province

2.

Preparer's Business or Organization Name

3.g. Postal Code
3.h. Country

Preparer's Mailing Address
3.a. Street Number
and Name

Interpreter's Contact Information
4.

Interpreter's Daytime Telephone Number

5.

Interpreter's Mobile Telephone Number (if any)

3.b.

Ste.

Flr.

3.c. City or Town
3.d. State
3.f.

6.

Apt.

Interpreter's Email Address (if any)

3.e. ZIP Code

Province

3.g. Postal Code
3.h. Country

Interpreter's Certification
I certify, under penalty of perjury, that:
I am fluent in English and

,

which is the same language specified in Part 5., Item Number
1.b., and I have read to this applicant in the identified language
every question and instruction on this application and his or her
answer to every question. The applicant informed me that he or
she understands every instruction, question, and answer on the
application, including the Applicant's Declaration and
Certification, and has verified the accuracy of every answer.

Preparer's Contact Information
4.

Preparer's Daytime Telephone Number

5.

Preparer's Mobile Telephone Number (if any)

6.

Preparer's Email Address (if any)

Interpreter's Signature
7.a. Interpreter's Signature

7.b. Date of Signature (mm/dd/yyyy)

Form I-539 Edition 03/10/21 E

Page 5 of 7

Part 7. Contact Information, Declaration, and
Signature of the Person Preparing this
Application, if Other Than the Applicant
(continued)
Preparer's Statement
7.a.

I am not an attorney or accredited representative but
have prepared this application on behalf of the
applicant and with the applicant's consent.

7.b.

I am an attorney or accredited representative and my
representation of the applicant in this case
extends
does not extend
beyond the
preparation of this application.

NOTE: If you are an attorney or accredited representative,
you may need to submit a completed Form G-28, Notice of
Entry of Appearance as Attorney or Accredited Representative,
with this application.

Preparer's Certification
By my signature, I certify, under penalty of perjury, that I
prepared this application at the request of the applicant. The
applicant then reviewed this completed application and
informed me that he or she understands all of the information
contained in, and submitted with, his or her application,
including the Applicant's Declaration and Certification, and
that all of this information is complete, true, and correct. I
completed this application based only on information that the
applicant provided to me or authorized me to obtain or use.

Preparer's Signature
8.a. Preparer's Signature

8.b. Date of Signature (mm/dd/yyyy)

Form I-539 Edition 03/10/21 E

Page 6 of 7

5.a. Page Number

Part 8. Additional Information
If you need extra space to provide any additional information
within this application, use the space below. If you need more
space than what is provided, you may make copies of this page
to complete and file with this application or attach a separate
sheet of paper. Type or print your name and A-Number (if any)
at the top of each sheet; indicate the Page Number, Part
Number, and Item Number to which your answer refers; and
sign and date each sheet.

5.b. Part Number

5.c. Item Number

6.b. Part Number

6.c. Item Number

7.b. Part Number

7.c. Item Number

5.d.

1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c. Middle Name
2.

A-Number (if any)
► A6.a. Page Number

3.a. Page Number

3.b. Part Number

3.c. Item Number
6.d.

3.d.

7.a. Page Number
4.a. Page Number

4.b. Part Number

4.c. Item Number
7.d.

4.d.

Form I-539 Edition 03/10/21 E

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