I-539, Application to Extend/
Change Nonimmigrant Status
Department of Homeland Security
U.S. Citizenship and Immigration Services
Part 2. Application type (See instructions for fee.)
Part 1. Information about you
1. I am applying for: (Check one.)
Part 3. Processing information
Part 4. Additional information
Expires on
(mm/dd/yyyy)
2. Foreign Address: Street Number and Name
Valid to: (mm/dd/yyyy)
2. Number of people included in this application: (Check one.)
Members of my family are filing this application with me.
The total number of people (including me) in the application is:
(Complete the supplement for each co-applicant.)
1. I/We request that my/our current or requested status be extended until
(mm/dd/yyyy):
4. If you answered "Yes" to Question 3, give the name of the petitioner or applicant:
Filed on (mm/dd/yyyy)
Date of Birth
(mm/dd/yyyy)
2. Is this application based on an extension or change of status already granted to your
spouse, child, or parent?
3. Is this application based on a separate petition or application to give your spouse,
child, or parent an extension or change of status?
1. For applicant #1, provide passport information:
From (Date):
To (Date):
Fill in box if G-28 is attached to
represent the applicant.
To Be Completed by
Attorney or Representative, if any
Yes No
3. Answer the following questions. If you answer "Yes" to any question, please describe the circumstances in
detail and explain on a separate sheet(s) of paper.
(d) Engaging in any kind of sexual contact or relations with any person who was being forced or
threatened?
(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?
Have you, or any other person included in this application, done anything that violated the terms of the nonimmigrant status you now hold?
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.
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.
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.
NOTE: If you do not completely fill out this form or fail to submit required documents listed in the instructions, you may not be found eligible for the requested benefit and this application may be denied.
Signature
Part 5. Applicant's Statement and Signature (Read the information on penalties in the instructions before completing this
section. You must file this application while in the United States).
Applicant's Statement (Check One):
Each and every question and instruction on this form, as well as my answer to each question, has been read to me by the person named below in
, a language in which I am fluent. I understand each and every question and instruction on this form, as well as my answer to each question.
Applicant's Signature
Part 6. Interpreter's Statement
Signature
Daytime Telephone Number
(Area Code and Number)
Fax Number (Area Code and Number)
Yes No
Part 4. (Continued) Additional information. Page for answers to 3f and 3g.
If you answered "Yes" to Question 3f in Part 4 on Page 3 of this form, give the following information concerning the removal proceedings. Include the name of the person in removal proceedings and information on jurisdiction, date proceedings began, and status of proceedings.
If you answered "No" to Question 3g in Part 4 on Page 3 of this form, fully describe how you are supporting yourself. Include the source, amount and basis for any income.
If you answered "Yes" to Question 3g in Part 4 on Page 3 of this form, fully describe the employment. Include the name of the person employed, name and address of the employer, weekly income, and whether the employment was specifically authorized by USCIS.
Part 7. Signature of Person Preparing Form, if Other than Above (Sign Below)
Signature
Daytime Telephone Number
(Area Code and Number)
Fax Number (Area Code and Number)
I declare that I prepared this application at the request of the above person and it is based on all information of which I have knowledge.
Supplement -1
Attach to Form I-539 when more than one person is included in the petition or application.
(List each person separately. Do not include the person named in the Form I-539.)
If you need additional space, attach a separate sheet(s) of paper.
Place your name, A #, if any, date of birth, form number, and application date at the top of the sheet(s) of paper.