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Application To Extend-Change Nonimmigrant Status I-539 - Official Federal Forms
| Application To Extend-Change Nonimmigrant Status Form. This is a national form and can be used in US Citizenship And Immigration Services . |
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OMB No. 1615-0003; Expires 12/31/2015 Department of Homeland Security U.S. Citizenship and Immigration Services I-539, Application to Extend/ Change Nonimmigrant Status For USCIS Use Only Returned START HERE - Please type or print in blue or black ink Part 1. Information About You Given Name (First Name) Middle Name Receipt Family Name (Last Name) Address In care of Street Number and Name City Country of Birth Date of Birth (mm/dd/yyyy) Date Resubmitted Apt. Number Date State Zip Code Daytime Phone Number Reloc Sent Country of Citizenship U. S. Social Security # (if any) I-94 Number Expires on (mm/dd/yyyy) A-Number (if any) Date Reloc Rec'd Date Applicant Interviewed on Date Extension Granted to (Date): Date of Last Arrival Into the U.S. Current Nonimmigrant Status Part 2. Application Type (See instructions for fee) 1. I am applying for: (Check one) a. An extension of stay in my current status. b. A change of status. The new status I am requesting is: c. Reinstatement to student status. 2. Number of people included in this application: (Check one) a. I am the only applicant. Members of my family are filing this application with me. b. The total number of people (including me) in the application is: (Complete the supplement for each co-applicant.) Part 3. Processing Information 1. I/We request that my/our current or requested status be extended until (mm/dd/yyyy): Change of Status/Extension Granted New Class: From (Date): To (Date): If Denied: Still within period of stay S/D to: Place under docket control Remarks: 2. Is this application based on an extension or change of status already granted to your spouse, child, or parent? No Yes. USCIS Receipt # 3. Is this application based on a separate petition or application to give your spouse, child, or parent an extension or change of status? No Yes, filed with this I-539. Yes, filed previously and pending with USCIS. Receipt #: 4. If you answered "Yes" to Question 3, give the name of the petitioner or applicant: If the petition or application is pending with USCIS, also give the following data: Office filed at Filed on (mm/dd/yyyy) Action Block Part 4. Additional Information 1. For applicant #1, provide passport information: Country of Issuance: 2. Foreign Address: Street Number and Name City or Town Country Valid to: (mm/dd/yyyy) Apt. Number State or Province Zip/Postal Code ATTY State License # Form I-539 (12/18/12) Y To Be Completed by Attorney or Representative, if any Fill in box if G-28 is attached to represent the applicant. American LegalNet, Inc. www.FormsWorkFlow.com 3. Answer the following questions. If you answer "Yes" to any question, describe the circumstances in detail and explain on a separate sheet of paper. a. b. c. Yes No Are you, or any other person included on the application, an applicant for an immigrant visa? Has an immigrant petition ever been filed for you or for any other person included in this application? 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? offense since last entering the United States? Have you EVER ordered, incited, called for, commited, assisted, helped with, or otherwise participated in any of the following: (a) Acts involving torture or genocide? (b) Killing any person? (c) Intentionally and severely injuring any person? (d) Engaging in any kind of sexual contact or relations with any person who was being forced or threatened? (e) Limiting or denying any person's ability to exercise religious beliefs? d. 1. Have you, or any other person included in this application, ever been arrested or convicted of any criminal d. 2. d. 3. Have you EVER: (a) Served in, been a member of, assisted in, or participated in any military unit, paramilitary unit, police unit, self-defense unit, vigilante unit, rebel group, guerrilla group, militia, or insurgent organization? (b) Served in any prison, jail, prison camp, detention facility, labor camp, or any other situation that involved detaining persons? d. 4. Have you EVER been a member of, assisted in, 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? d. 5. Have you EVER assisted or participated in selling or providing weapons to any person who to your knowledge used them against another person, or in transporting weapons to any person who to your knowledge used them against another person? d. 6. Have you EVER received any type of military, paramilitary, or weapons training? e. f. g. Have you, or any other person included in this application, done anything that violated the terms of the nonimmigrant status you now hold? Are you, or any other person included in this application, now in removal proceedings? 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? 1. If you answered "Yes" to Question 3f, give the following information concerning the removal proceedings on the attached page entitled "Part 4. Additional information. Page for answers to 3f and 3g." Include the name of the person in removal proceedings and information on jurisdiction, date proceedings began, and status of proceedings. 2. If you answered "No" to Question 3g, fully describe how you are supporting yourself on the attached page entitled "Part 4. Additional information. Page for answers to 3f and 3g." Include the source, amount, and basis for any income. 3. If you answered "Yes" to Question 3g, fully describe the employment on the attached page entitled "Part 4. Additional information. Page for answers to 3f and 3g." Include the name of the person employed, name and address of the employer, weekly income, and whether the employment was specifically authorized by USCIS. Form I-539 (12/18/12) Y Page 2 American LegalNet, Inc. www.FormsWorkFlow.com Yes h. No Are you currently or have you ever been a J-1 exchange visitor or a J-2 dependent of a J-1 exchange visitor? If "Yes," you must provide the dates you maintained status as a J-1 exchange visitor or J-2 dependent. Willful failure to disclose this information (or other relevant information) can result in your application being denied. Also, provide proof of your J-1 or J-2 status, such as a copy of Form DS-2019, Certificate of Eligibility for Exchange Visitor Status, or a copy of your passport that includes the J visa stam
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