Form I-539 Edition 04/01/24 Page 1 of 7

Application to Extend/Change Nonimmigrant Status 

Department of Homeland Security 

U.S. Citizenship and Immigration Services

USCIS 

Form I-539 

OMB No. 1615-0003 

Expires 02/28/2027

Part 1. Information About You

1.a. Family Name 

(Last Name)

1.b. Given Name 

(First Name)

1.c. Middle Name

U.S. Mailing Address

4.d. City or Town

4.a. In Care Of Name (if any)

4.e. State 4.f. ZIP Code

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

8. Date of Birth (mm/dd/yyyy)

►

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

Street Number 

and Name

4.b. 

4.c. Apt. Ste. Flr.

Remarks:

New Class

 Denied

Still within period of stay

S/D to:

Place under docket control

From / / /

To / / /

For USCIS Use Only Action Block

Sent

Received Relocated

Fee Stamp

Resubmitted

Returned

Applicant interviewed on

Granted

Dates:

7. Country of Citizenship or Nationality

6. Country of Birth

Other Information About You

3. USCIS Online Account Number (if any)

►

► A2. Alien Registration Number (A-Number) (if any)

Your Full Name

5.b. Apt. Ste. Flr.

5.a. Street Number 

and Name

5.d. State 5.e. ZIP Code

5.c. City or Town

U.S. Physical Address

11. Form I-94 Arrival-Departure Record Number

►

Provide Information About Your Most Recent Entry Into the 

United States

Select this box if 

Form G-28 is 

attached.

Attorney State Bar Number 

(if applicable)

Attorney or Accredited Representative 

USCIS Online Account Number (if any) To be completed by an 

Attorney or Accredited 

Representative (if any).

12. Passport Number

► START HERE - Type or print in black ink.

(USPS ZIP Code Lookup)
Form I-539 Edition 04/01/24 Page 2 of 7

Current Nonimmigrant Status (e.g. F-1 student, H-4 

dependent, etc.)

15.a.

14.b. Passport or Travel Document Expiration Date 

(mm/dd/yyyy)

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

16. Select this box if you were granted Duration of Status 

(D/S).

14.a. Country of Passport or Travel Document Issuance

Part 1. Information about You (continued)

1. Reinstatement to student status.

An extension of stay in my current status.

4. I am the only applicant.

5.a. 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 coapplicant.)

2.

3.c.

A change of status. 

The change of status I am requesting is:

I am applying for (select only one box):

Number of people included in this application (select only one

box):

Part 2. Application Type 

5.b.

3.b.

3.a.

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

►

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

5. Date Filed (mm/dd/yyyy)

4. First and Last Name of Petitioner or Applicant

Yes, filed with this Form I-539. No

Yes, filed previously and pending with U.S. 

Citizenship and Immigration Services (USCIS).

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?

If the petition or application is pending with USCIS, also 

provide the following information:

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 No

Provide Your Current Passport Information (if different from 

Part 1.)

Part 4. Additional Information About the 

Applicant

1.c. Passport Expiration Date (mm/dd/yyyy)

Country of Passport Issuance 

1.a. Passport Number

1.b.

Physical Address Abroad

Street Number 

and Name

2.a. 

2.c. City or Town

2.d. Province

2.e. Postal Code

2.f. Country

2.b. Apt. Ste. Flr.

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.

13. Travel Document Number

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

USCIS Receipt Number.

►
Form I-539 Edition 04/01/24 Page 3 of 7

3. Are you, or any other person included on the application, 

an applicant for an immigrant visa? Yes No

5.

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?

6.

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 No

Yes No

Has an immigrant petition EVER been filed for you or for 

any other person included in this application?

4.

Yes No

10. 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?

Yes No

11. Have you, or any other person included in this 

application, EVER received any type of military, 

paramilitary, or weapons training? Yes No

12.

13. Are you, or any other person included in this application, 

now in removal proceedings?

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

Yes No

Part 4. Additional Information About the 

Applicant (continued)

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:

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?

Intentionally and severely injuring any person?

Killing any person?

Acts involving torture or genocide?

Yes No

Yes No

Yes No

7.a. Yes No

7.b.

7.c.

7.d.

Limiting or denying any person's ability to exercise 

religious beliefs?

7.e.

Yes No

Have you, or any other person included on the application, 

EVER:

Yes No

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?

9.

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?

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

8.a.

8.b.

Yes No

14.

Yes No

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?

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.

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.

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.

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
Form I-539 Edition 04/01/24 Page 4 of 7

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.a.

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.b. The interpreter named in Part 6. read to me every 

question and instruction on this application and my 

answer to every question in

a language in which I am fluent, and I understood 

everything. 

,

,

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

prepared this application for me based only upon 

information I provided or authorized. 

3. Applicant's Daytime Telephone Number

5. Applicant's Email Address (if any)

4. Applicant's Mobile Telephone Number (if any)

Applicant's Contact Information

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.

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.

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: 

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. 

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.

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

6.a. Applicant's Signature

Applicant's Signature

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

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

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

2. Interpreter's Business or Organization Name (if any)

Interpreter's Full Name

Provide the following information about the interpreter.

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. 
Form I-539 Edition 04/01/24 Page 5 of 7

3.h.

Interpreter's Mailing Address

3.c. City or Town

3.d. State 3.e. ZIP Code

3.g. Postal Code 

Street Number 

and Name

3.a.

Country 

3.b. Apt. Ste. Flr.

3.f. Province 

 Interpreter's Contact Information

4. Interpreter's Daytime Telephone Number

6. Interpreter's Email Address (if any)

5. Interpreter's Mobile Telephone Number (if any)

Interpreter's Certification

I certify, under penalty of perjury, that:

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.

I am fluent in English and , 

Preparer's Full Name

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

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

Part 7. Contact Information, Declaration, and 

Signature of the Person Preparing this 

Application, if Other Than the Applicant

2. Preparer's Business or Organization Name

Provide the following information about the preparer.

3.h.

3.g. Postal Code 

Country 

3.f. Province 

 Preparer's Contact Information

4. Preparer's Daytime Telephone Number

6. Preparer's Email Address (if any)

5. Preparer's Mobile Telephone Number (if any)

Preparer's Mailing Address

3.c. City or Town

3.d. State 3.e. ZIP Code

Street Number 

and Name

3.a.

3.b. Apt. Ste. Flr.

Part 6. Interpreter's Contact Information, 

Statement, Certification, and Signature 

(continued)

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

7.a. Interpreter's Signature

Interpreter's Signature
Form I-539 Edition 04/01/24 Page 6 of 7

Part 7. Contact Information, Declaration, and 

Signature of the Person Preparing this 

Application, if Other Than the Applicant 

(continued)

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.a.

7.b.

preparation of this application.

I am an attorney or accredited representative and my 

representation of the applicant in this case

extends does not extend beyond the 

 Preparer's Statement

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.

8.a. Preparer's Signature

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

 Preparer's Signature
Form I-539 Edition 04/01/24 Page 7 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. 

A-Number (if any)

► A3.a.

2.

Page Number 3.b. Part Number 3.c. Item Number

3.d.

Page Number Part Number Item Number

1.b. 

1.c.

1.a. Family Name 

(Last Name) 

Given Name 

(First Name) 

Middle Name

4.b. 4.c.

4.d.

4.a.

5.a. Page Number Part Number Item Number

Page Number

5.b.

Part Number

5.c.

Item Number

5.d.

Page Number Part Number Item Number

6.d.

6.a. 6.b. 6.c.

7.a. 7.b. 7.c.

7.d.