Form I-539 02/04/19 Application to Extend/Change Nonimmigrant Status Department of Homeland Security U.S. Citizenship and Immigration ServicesUSCIS Form I-539 OMB No. 1615-0003 Part 1. Information About You1.a.Family Name (Last Name) 1.b. Given Name (First Name) 1.c. Middle Name U.S. Mailing Address4.d.City or Town4.a.In Care Of Name (if any) 4.e.State4.f.ZIP Code10.Date of Last Arrival Into the United States (mm/dd/yyyy) Date of Birth (mm/dd/yyyy)4.c. Ste. Flr. Apt. Remarks:New Class DeniedStill within period of stayS/D to:Place under docket control From / / / To / / / For USCIS Use Only Action BlockSentReceivedRelocatedFee StampResubmitted ReturnedApplicant interviewed on Granted Dates:7.Country of Citizenship or Nationality Country of Birth6. Other Information About YouUSCIS Online Account Number (if any)3.A-Alien Registration Number (A-Number) (if any)2. Your Full Name Apt. Flr. Ste.5.b. 5.a. Street Number and NameZIP Code5.e.State5.d.City or Town5.c. U.S. Physical Address Form I-94 Arrival-Departure Record Number11.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 Passport Number12. START HERE - Type or print in black ink. (USPS ZIP Code Lookup) American LegalNet, Inc. www.FormsWorkFlow.com Form I-539 02/04/19 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) Expiration Date (mm/dd/yyyy) 15.b. 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 co-applicant.)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. Page 2 of 73.b.3.a.New status and effective date of change (mm/dd/yyyy) If pending with USCIS, provide USCIS Receipt Number.3.b.Date Filed (mm/dd/yyyy)5.4.First and Last Name of Petitioner or Applicant No Yes, filed with this Form I-539. 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? No Yes Provide Your Current Passport Information (if different from Part 1.) Part 4. Additional Information About the Applicant1.c.Passport Expiration Date (mm/dd/yyyy)Country of Passport Issuance Passport Number1.a.1.b. Physical Address AbroadStreet Number and Name2.a. 2.c. City or Town2.d. Province2.e.Postal Code2.f.Country 2.b. Ste. Flr. Apt. Answer the following questions. If you answer 223Yes224 to any of the questions in Item Numbers 3. - 15., use the space provided in Part 8. Additional Information to provide an explanation. Travel Document Number13. 2.b.If you answered "Yes" to Item Number 2.a., provide USCIS Receipt Number. American LegalNet, Inc. www.FormsWorkFlow.com Form I-539 02/04/19 3.Are you, or any other person included on the application, an applicant for an immigrant visa? No Yes5.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? No Yes Yes NoHas an immigrant petition EVER been filed for you or for any other person included in this application?4. Yes No10.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 No11.Have you, or any other person included in this application, EVER received any type of military, paramilitary, or weapons training? Yes No12.13.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?240 Yes No Yes NoPage 3 of 7 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? No Yes No Yes No Yes No Yes7.a.7.b.7.c.7.d.Limiting or denying any person's ability to exercise religious beliefs?7.e. Yes NoHave you, or any other person included on the application, EVER: Yes NoHave 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 No8.a.8.b. No Yes14. No YesHave 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.240 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 American LegalNet, Inc. www.FormsWorkFlow.com Form I-539 02/04/19 Page 4 of 7I 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 StatementNOTE: Select the box for either Item Number 1.a. or 1.b.240 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 bas