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
Fee Stamp

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

OMB No. 1615-0003
Expires 12/31/2024

Action Block

Denied

DRAFT
NOT FOR
PRODUCTION
05/24/2023
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
1.

Your Full Legal Name

Family Name (Last Name)

Given Name (First Name)

2.

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

3.

4.

Your U.S. Mailing Address (Safe Address, if applicable)

Middle Name (if applicable)

USCIS Online Account Number (if any)
►

In Care Of Name (if any)

5.

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Is your mailing address the same as your physical address?

ZIP Code

Yes

No

If you answered “Yes” to Item Number 5. skip to Item Number 7. If you answered “No” to Item Number 5., provide
information on your physical address in Item Number 6.
6.

Your Current Physical Address
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Form I-539 Edition 05/31/22

ZIP Code

Page 1 of 7

Part 1. Information About You (continued)
Other Information About You
7.

Country of Birth

9.

Date of Birth (mm/dd/yyyy)

11.

Provide Information About Your Most Recent Entry Into the United States
Date of Last Arrival Into the
United States (mm/dd/yyyy)

8.

10.

Country of Citizenship or Nationality

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

Form I-94 Arrival-Departure
Record Number

Passport Number
(if any)

DRAFT
NOT FOR
PRODUCTION
05/24/2023
►

Travel Document Number
(if any)

12.

Country of Passport or
Travel Document Issuance

Current Nonimmigrant Status (for example, F-1 student, H-4 dependent, etc.)

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

Date Status Expires (mm/dd/yyyy)

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

Part 2. Application Type
1.

I am applying for (select only one box):
Reinstatement to student status.

An extension of stay in my current status.
A change of status.

2.

If you are applying for a change of status or change of employer/information medium, complete the following:
I am requesting to change my status or employer/information
medium to:

3.

I am requesting the change to be effective
(mm/dd/yyyy)

Number of people included in this application (select only one box):
I am the only applicant.

I am filing this application for myself and members of my family.
4.

The total number of people (including me) in the application is: (Form I-539A is required for each co-applicant.)

5.

The name of the school you will attend (if applicable) as an Academic Student, Vocational Student, or Exchange Visitor.

6.

Your Student and Exchange Visitor Information System (SEVIS) ID Number, if applicable.

Part 3. Processing Information
1.

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

2.

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

Form I-539 Edition 05/31/22

Yes

No

Page 2 of 7

Part 3. Processing Information (continued)
3.

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

4.

If you answered "Yes" to Item Number 2. or Item Number 3., select the Form type below.
Form I-539, Application to Extend/Change Nonimmigrant Status

DRAFT
NOT FOR
PRODUCTION
05/24/2023
Form I-129, Petition for a Nonimmigrant Worker

5.

If you answered "Yes" to Item Number 2. or 3., provide the USCIS Receipt Number.

►

If the petition or application is pending with USCIS, also provide the following information:
6.

First and Last Name of Beneficiary or Applicant
First Name of Beneficiary or Applicant

7.

Last Name of Beneficiary or Applicant

Date Filed (mm/dd/yyyy)

Part 4. Additional Information About the Principal Applicant
1.

Current Passport Information

If your current passport information is different from the information you provided in Part 1., provide your current passport
information. If your current passport information matches the information you provided in Part 1., proceed to Item Number 3.
Passport Number

2.

Country of Passport Issuance

Passport Expiration Date (mm/dd/yyyy)

Physical Address Abroad

Street Number and Name

Apt.Ste. Flr. Number

City or Town

Province

Postal Code

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.
3.

Are you an applicant for an immigrant visa?

Yes

No

4.

Has an immigrant petition EVER been filed for you?

Yes

No

5.

Have you EVER filed Form I-485, Application to Register Permanent Residence or Adjust Status?

Yes

No

Form I-539 Edition 05/31/22

Page 3 of 7

Part 4. Additional Information About the Applicant (continued)
6.

Have you been arrested or convicted of any criminal offense since last entering the United States?

Yes

No

Have you 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.c. Intentionally and severely injuring any person?

Yes

No

DRAFT
NOT FOR
PRODUCTION
05/24/2023

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

7.e. Limiting or denying any person's ability to exercise religious beliefs?

Yes

No

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

No

9.

Have you EVER been a member of, assisted, or participated in any group, unit, or organization of any kind
in which you or other persons used or threatened to use any type of weapon against any person or
threatened to do so?

Yes

No

10.

Have you EVER sold, provided, or transported weapons, or assisted any person in selling, providing, or
transporting weapons, which, you knew or believed would be used against another person?

Yes

No

11.

Have you EVER received any weapons training, paramilitary training, or other military-type training?

Yes

No

12.

Have you EVER violated the terms of the nonimmigrant status you now hold?

Yes

No

13.

Are you now in removal proceedings?

Yes

No

14.

Have you EVER been employed in the United States since last admitted or granted an extension or change
of status?

Yes

No

Have you EVER:

8.a. Served in, been a member of, assisted, or participated in any military unit, paramilitary unit, police unit, selfdefense unit, vigilante unit, rebel group, guerrilla group, militia, insurgent organization, or any other armed
group?

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 any and all periods of employment in Part 8. Additional Information.
Include the name and address of the employer, weekly income, and whether the employment was specifically authorized by USCIS.
15.

Are you 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.

Form I-539 Edition 05/31/22

Page 4 of 7

Part 5. Applicant's Contact Information, Certification, and Signature
Applicant's Contact Information
Provide your daytime telephone number, mobile telephone number (if any), and email address (if any).
1.

Applicant's Daytime Telephone Number

3.

Applicant's Email Address (if any)

2.

Applicant's Mobile Telephone Number (if any)

DRAFT
NOT FOR
PRODUCTION
05/24/2023

Applicant's Certification and Signature

I certify, under penalty of perjury, that I provided or authorized all of the responses and information contained in and submitted with
my application, I read and understand or, if interpreted to me in a language in which I am fluent by the interpreter listed in Part 6.,
understood, all of the responses and information contained in, and submitted with, my application, and that all of the responses and the
information are complete, true, and correct. Furthermore, I authorize the release of any information from any and all of my records
that USCIS may need to determine my eligibility for an immigration request and to other entities and persons where necessary for the
administration and enforcement of U.S. immigration law.
4.

Applicant's Signature

Date of Signature (mm/dd/yyyy)

Part 6. Interpreter's Contact Information, Certification, and Signature
Interpreter's Full Name
1.

Interpreter's Family Name (Last Name)

2.

Interpreter's Business or Organization Name

Interpreter's Given Name (First Name)

Interpreter's Contact Information
3.

Interpreter's Daytime Telephone Number

5.

Interpreter's Email Address (if any)

4.

Interpreter's Mobile Telephone Number (if any)

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

, and I have interpreted

every question on the application and Instructions and interpreted the applicant's answers to the questions in that language, and the
applicant informed me that they understood every instruction, question, and answer on the application.
6.

Interpreter's Signature

Date of Signature (mm/dd/yyyy)

Form I-539 Edition 05/31/22

Page 5 of 7

Part 7. Contact Information, Declaration, and Signature of the Person Preparing this Application, if
Other Than the Applicant
Preparer's Full Name
1.

Preparer's Family Name (Last Name)

2.

Preparer's Business or Organization Name

Preparer's Given Name (First Name)

DRAFT
NOT FOR
PRODUCTION
05/24/2023

Preparer's Contact Information
3.

Preparer's Daytime Telephone Number

5.

Preparer's Email Address (if any)

4.

Preparer's Mobile Telephone Number (if any)

Preparer's Certification and Signature

I certify, under penalty of perjury, that I prepared this application for the applicant at their request and with express consent and that
all of the responses and information contained in and submitted with the application are complete, true, and correct and reflects only
information provided by the applicant. The applicant reviewed the responses and information and informed me that they understand
the responses and information in or submitted with the application.
6.

Preparer's Signature

Form I-539 Edition 05/31/22

Date of Signature (mm/dd/yyyy)

Page 6 of 7

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.
1.

Family Name (Last Name)

Given Name (First Name)

2.

A-Number

3.

Page Number

Part Number

Item Number

4.

Page Number

Part Number

Item Number

5.

Page Number

Part Number

Item Number

6.

Page Number

Part Number

Item Number

Middle Name (if applicable)

► A-

DRAFT
NOT FOR
PRODUCTION
05/24/2023

Form I-539 Edition 05/31/22

Page 7 of 7