Change or Extension of Status Questionnaire

SECTION 01 · I-539 1, 5

Applicant Contact Information

Only the principal applicant’s first name, last name, and email address are required. All other answers are optional. Please answer accurately; the firm will review the completed intake before filing.

Applicant first / given name *

Applicant family / last name *

Applicant email address *

Daytime telephone number

Mobile telephone number

Other contact instructions

SECTION 02 · I-539 1–2

Principal Applicant Identity — Part 1

Only the principal applicant’s first name, last name, and email address are required. All other answers are optional. Please answer accurately; the firm will review the completed intake before filing.

Middle name (if any)

Alien Registration Number (A-Number), if any

USCIS online account number (if any)

Date of birth

Country of birth

Country of citizenship or nationality

US Social Security Number (if any)

Other names / identity details for review

SECTION 03 · I-539 1

US Mailing and Physical Addresses — Part 1

Only the principal applicant’s first name, last name, and email address are required. All other answers are optional. Please answer accurately; the firm will review the completed intake before filing.

Mailing address in care of name

Mailing street number and name

Mailing address unit type

Mailing address unit number

Mailing address city or town

Mailing address state

Mailing address ZIP code

Is the mailing address also your physical address?

Physical street number and name (if different)

Physical address unit type

Physical address unit number

Physical city

Physical state

Physical ZIP code

SECTION 04 · I-539 2

Most Recent Entry and Current Status — Part 1

Only the principal applicant’s first name, last name, and email address are required. All other answers are optional. Please answer accurately; the firm will review the completed intake before filing.

Most recent date of arrival into the US

Most recent Form I-94 arrival/departure record number

Passport number used at last entry

Travel document number used at last entry, if any

Country of passport or travel document issuance

Expiration date of passport or travel document used at last entry

Current nonimmigrant status (example: B-2, F-1, H-4)

Current status expiration date (if fixed)

Was your status granted for duration of status (D/S)?

Additional entry or status details

SECTION 05 · I-539 2

Request Type and Family Members — Part 2

Only the principal applicant’s first name, last name, and email address are required. All other answers are optional. Please answer accurately; the firm will review the completed intake before filing.

I-539 application type

Requested nonimmigrant classification or employer/information medium

Requested effective date of status change

Who is included in this application?

Total people in this I-539 application (including you)

School name (if academic or vocational student or exchange visitor)

SEVIS ID (if any)

Explain the requested extension, change or reinstatement

SECTION 06 · I-539 2–3

Processing and Related Petitions — Part 3

Only the principal applicant’s first name, last name, and email address are required. All other answers are optional. Please answer accurately; the firm will review the completed intake before filing.

Requested extension of present or requested status until

Based on an extension/change already granted to spouse, child or parent?

Separate petition/application for spouse, child or parent

Related form

USCIS receipt number for related petition/application

Related beneficiary/applicant first name

Related beneficiary/applicant family name

Date related petition/application filed

Additional information about related petition or immigration request

SECTION 07 · I-539 3

Current Passport and Address Abroad — Part 4

Only the principal applicant’s first name, last name, and email address are required. All other answers are optional. Please answer accurately; the firm will review the completed intake before filing.

Current passport number (only if changed since last entry)

Current passport issuing country, if changed

Current passport expiration, if changed

Physical address abroad: street

Apartment/suite/floor abroad

City or town abroad

State or province abroad

Postal code abroad

Country abroad

SECTION 08 · I-539 3–4

Immigrant Filing and Criminal History — Part 4

Only the principal applicant’s first name, last name, and email address are required. All other answers are optional. Please answer accurately; the firm will review the completed intake before filing.

Are you an applicant for an immigrant visa?

Has an immigrant petition ever been filed for you?

Have you ever filed Form I-485?

Have you been arrested or convicted of a criminal offense since last entering the US?

Explain any Yes response above, with dates and case details

SECTION 09 · I-539 4

Human Rights, Weapons, and Security Questions — Part 4

Only the principal applicant’s first name, last name, and email address are required. All other answers are optional. Please answer accurately; the firm will review the completed intake before filing.

Ever involved in acts of torture or genocide?

Ever involved in killing any person?

Ever involved in intentionally and severely injuring any person?

Ever involved in nonconsensual or coerced sexual contact?

Ever involved in limiting or denying religious belief?

Ever served in or assisted a military, paramilitary, police, militia, rebel, or other armed group?

Ever worked or assisted at a prison, jail, detention center or similar facility?

Ever participated in an organization involving use or threats of weapons?

Ever sold, provided or transported weapons you believed would be used against others?

Ever received weapons, paramilitary, or military-type training?

Explain all relevant Yes responses to the questions above

SECTION 10 · I-539 4

Status Compliance, Employment, and Exchange History — Part 4

Only the principal applicant’s first name, last name, and email address are required. All other answers are optional. Please answer accurately; the firm will review the completed intake before filing.

Have you ever violated the terms of your current nonimmigrant status?

Are you currently in removal proceedings?

Have you worked in the US since last admission or extension/change of status?

All US employment since most recent admission or extension/change

Add as many entries as needed (up to twelve).

Entry 1

Employer legal name

Employer street and city

From date

To date

Weekly income

Was this work specifically authorized by USCIS?

Employment details

If you have not worked, explain how you have supported yourself (source, amount, basis of income)

Have you ever held J-1 or J-2 status?

All J-1 / J-2 periods

Add as many entries as needed (up to twelve).

Entry 1

J-1 or J-2

Start date

End date

Program and DS-2019 details

Explain any status violations, proceedings, unauthorized work, or J history

SECTION 11 · I-539A 1–5

Family Co-applicants — One I-539A Per Person

Only the principal applicant’s first name, last name, and email address are required. All other answers are optional. Please answer accurately; the firm will review the completed intake before filing.

Co-applicants (one separate entry for each family member)

Add one separate complete entry for each family member. Their individual eligibility answers must be provided separately.

Entry 1

Identity and Immigration Documents

Co-applicant family name

Co-applicant first name

Co-applicant middle name

Date of birth

Country of birth

Country of citizenship

Social Security Number (if any)

A-Number (if any)

Most recent US arrival date

I-94 number

Passport number at last entry

Travel document number

Country of document issuance

Passport/travel document expiration at last entry

Current nonimmigrant status

Current status expiration date or D/S

Current passport number if changed

Current passport country if changed

Current passport expiration if changed

USCIS online account number

Immigration History and Eligibility

Applicant for an immigrant visa?

Immigrant petition ever filed?

Ever filed Form I-485?

Arrested or convicted since most recent US entry?

Ever involved in torture or genocide?

Ever involved in killing a person?

Ever involved in severe injury to another?

Ever involved in nonconsensual sexual contact?

Ever limited another person’s religious beliefs?

Ever served in or assisted military/police/militia or armed group?

Ever worked or helped in prison or detention facility?

Ever participated in threatening use of weapons?

Ever sold or transported weapons intended for harm?

Ever had military/weapons training?

Status, Employment, and Exchange Visitor History

Ever violated current status?

Currently in removal proceedings?

Worked in US since most recent admission or status extension/change?

Each US employment period, employer, wages and authorization

If not employed, how supported (source/amount/basis)?

Ever held J-1 or J-2 status?

Dates and details of all J-1 / J-2 periods

Contact and Additional Explanations

Daytime phone

Mobile phone

Email address

Details/explanations of any Yes answers, keyed to I-539A Part/Item

Other information for this co-applicant

SECTION 12 · I-539 7

Additional Information — I-539 Part 8

Only the principal applicant’s first name, last name, and email address are required. All other answers are optional. Please answer accurately; the firm will review the completed intake before filing.

Additional information referenced by form page/part/item

Add as many entries as needed (up to twelve).

Entry 1

I-539 page number

Form part number

Item number

Complete explanation

Any other information your attorney should review

SECTION 13 · I-539 and I-539A

Review and Submit

Only the principal applicant’s first name, last name, and email address are required. All other answers are optional. Please answer accurately; the firm will review the completed intake before filing.

Final comments for the firm (optional)

Change or Extension of Status Questionnaire

Applicant Contact Information

Principal Applicant Identity — Part 1

US Mailing and Physical Addresses — Part 1

Most Recent Entry and Current Status — Part 1

Request Type and Family Members — Part 2

Processing and Related Petitions — Part 3

Current Passport and Address Abroad — Part 4

Immigrant Filing and Criminal History — Part 4

Human Rights, Weapons, and Security Questions — Part 4

Status Compliance, Employment, and Exchange History — Part 4

Family Co-applicants — One I-539A Per Person

Additional Information — I-539 Part 8

Review and Submit

Secure verification