This form contains 159 fields organized into 54 sections, giving it a Form Complexity Index of 66/100 (complex). Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
Applicant Full Legal Name
Family Name (Last Name)	Text	Enter your full legal family name or last name.
Given Name (First Name)	Text	Enter your full legal given name or first name.
Middle Name	Text	Enter your full legal middle name, if applicable.
Applicant Identification Numbers
Alien Registration Number (A-Number)	Text	Enter your Alien Registration Number (A-Number), if one has been assigned to you. Max length: 9 characters
USCIS Online Account Number	Text	Enter your USCIS Online Account Number, if you have one. Max length: 12 characters
Applicant Name and A-Number
Family Name (Last Name)	Text	Enter the applicant's family name or surname.
Given Name (First Name)	Text	Enter the applicant's given or first name.
Middle Name	Text	Enter the applicant's middle name, if applicable.
A-Number	Text	Enter the applicant's Alien Registration Number (A-Number). Max length: 9 characters
Applicant's Certification and Signature
Applicant Signature	Text	Enter the applicant's signature to certify that the information provided in the application is complete, true, and correct.
Date of Signature	Date	Enter the date on which the applicant signed the certification.
Applicant's Contact Information
Applicant's Daytime Telephone Number	Text	Enter the applicant's daytime telephone number. Max length: 15 characters
Applicant's Mobile Telephone Number	Text	Enter the applicant's mobile telephone number, if any. Max length: 15 characters
Applicant's Email Address	Text	Enter the applicant's email address, if any. Max length: 38 characters
Applicants Included and Total Count
I am the only applicant	Checkbox	Check this box if you are the only person included in this application.
I am filing this application for myself and members of my family	Checkbox	Check this box if this application includes you and one or more members of your family.
Total Number of People in Application	Text	Enter the total number of people included in this application, including yourself. Max length: 2 characters
Application Type Selection
Extension of stay in current status	Checkbox	Check this box if you are applying to extend your stay in your current status.
Change of status	Checkbox	Check this box if you are applying to change your immigration status.
Reinstatement to student status	Checkbox	Check this box if you are applying to be reinstated to student status.
Attorney or Accredited Representative Information
Form G-28 Attached	Checkbox	Check this box if an attorney or accredited representative is submitting Form G-28 with this application.
Attorney State Bar Number	Text	Enter the attorney's state bar membership or license number, if applicable.
USCIS Online Account Number	Number	Enter the attorney's or accredited representative's USCIS Online Account Number, if any. Max length: 12 characters
Criminal Offense Since Last Entry
Yes	Checkbox	Check this box if you have been arrested or convicted of any criminal offense since last entering the United States.
No	Checkbox	Check this box if you have not been arrested or convicted of any criminal offense since last entering the United States.
Current Nonimmigrant Status Information
Current Nonimmigrant Status	Combobox	Enter your current nonimmigrant immigration status, such as F-1 student or H-4 dependent. FUG A3 H3B 1B2 E3 X V3 P1S OP V1 PI WB L1 T4 K1 ML H3 H2R MIS N4 F2 WT J1S M1 N2 UU PAR P3 U3 N7 D2 P4 K4 B1B T5 O3 N9 R2 AS DA A1 H1A S2 BE TWO 1B3 1B1 C1 1 RE N5 N6 WD A2 RW PAL T2 CW1 1B4 UN EWI GB N1 CP DT TC L1A P1 S1 Q1 B1A K2 M2 T3 J2S B1D DX U4 G4 IN GT H3A H4 U2 H1 N8 P2S RE5 P3S DE E2 TB IMM C2 HSC TD E2C ST G5 SDF EAO CC I G3 H2B H1B J1 0 C4 H1C U5 N3 WI O1A ASD J2 FSM S9 TN2 CH H2 B1 TN1 V2 O2 H2A P2 K3 F1 T1 B1C L1B G2 P1A R1 L2 CW2 G1 AW 1B5 C3 D1 Q3 U1 E1 P1B 1BS B2 LZ O1 O1B
Date Status Expires	Date	Enter the date your current nonimmigrant status expires. Fill only if 'Granted Duration of Status (D/S)' is 'No'. Depends on: Granted Duration of Status (D/S)
Granted Duration of Status (D/S)	Checkbox	Check this box if you were granted Duration of Status (D/S) for your current nonimmigrant status.
Current Passport Information
Current Passport Expiration Date	Date	Enter the expiration date shown on your current passport. Fill only if 'Current Passport Information' is different from the information provided in Part 1. Depends on: Passport or Travel Document Expiration Date
Country of Passport Issuance	Text	Enter the country that issued your current passport. Fill only if 'Current Passport Information' is different from the information provided in Part 1. Depends on: Passport or Travel Document Issuing Country
Current Passport Number	Text	Enter the number shown on your current passport. Fill only if 'Current Passport Information' is different from the information provided in Part 1. Depends on: Passport Number
Current Physical Address
Physical Address Street Number and Name	Text	Enter the street number and street name for your current physical address. Fill only if 'No' is 'No'. Max length: 34 characters Depends on: No
Apartment	Checkbox	Check this box if your current physical address includes an apartment number, then enter the apartment number. Fill only if 'No' is 'No'. Depends on: No
Suite	Checkbox	Check this box if your current physical address includes a suite number, then enter the suite number. Fill only if 'No' is 'No'. Depends on: No
Floor	Checkbox	Check this box if your current physical address includes a floor number, then enter the floor number. Fill only if 'No' is 'No'. Depends on: No
Physical Address Apartment, Suite, or Floor Number	Text	Enter the apartment, suite, or floor number for your current physical address, if applicable. Fill only if 'No' is 'No'. Max length: 6 characters Depends on: No
Physical Address City or Town	Text	Enter the city or town of your current physical address. Fill only if 'No' is 'No'. Max length: 28 characters Depends on: No
Physical Address State	Combobox	Enter the state of your current physical address. Fill only if 'No' is 'No'. ID PA NH NY GA SD CA VA ND AA VT WV RI MD OK IN MH LA AE GU AZ MN OH NV VI NM DE MS PR NJ WA MO MT MI PW KS CO MA KY TX NC NE ME UT IA AP FL AR MP TN AK DC AL FM CT OR SC WI HI WY IL AS Depends on: No
Physical Address ZIP Code	Text	Enter the ZIP Code for your current physical address. Fill only if 'No' is 'No'. Max length: 5 characters Depends on: No
Detention Facility Service
No — Detention Facility Service	Checkbox	Check this box if you have never worked, volunteered, or otherwise served in a prison, jail, prison camp, detention facility, labor camp, or another setting involving detaining persons.
Yes — Detention Facility Service	Checkbox	Check this box if you have ever worked, volunteered, or otherwise served in a prison, jail, prison camp, detention facility, labor camp, or another setting involving detaining persons.
First Additional Information Entry
Page Number	Text	Enter the page number of the application page to which this additional information refers. Max length: 2 characters
Part Number	Text	Enter the part number of the application section to which this additional information refers. Max length: 6 characters
Item Number	Text	Enter the item number within the identified part to which this additional information refers. Max length: 6 characters
Additional Information	Text	Provide the additional information or explanation that relates to the specified page, part, and item number. Fill only if 'Are you currently or have you EVER been a J-1 exchange visitor or a J-2 dependent of a J-1 exchange visitor?' is 'Yes'. Depends on: Yes — J-1 Exchange Visitor or J-2 Dependent Status
Footer Form Field
Footer Form Field	Text	Enter the required value in the form footer field.
Form Footer Field
Form Page Number	Text	Enter the page number shown in the form footer.
Fourth Additional Information Entry
Additional Information Page Number	Text	Enter the page number of the application page to which this additional information refers. Max length: 2 characters
Additional Information Part Number	Text	Enter the part number of the application section to which this additional information refers. Max length: 6 characters
Additional Information Item Number	Text	Enter the item number of the application question to which this additional information refers. Max length: 6 characters
Fourth Additional Information Entry	Text	Provide the additional information that corresponds to the page, part, and item number entered above. Fill only if 'Are you currently or have you EVER been a J-1 exchange visitor or a J-2 dependent of a J-1 exchange visitor?' is 'Yes'. Depends on: Yes — J-1 Exchange Visitor or J-2 Dependent Status
Immigrant Petition Filed
Yes — Immigrant Petition Ever Filed	Checkbox	Check this box if an immigrant petition has ever been filed for you.
No — Immigrant Petition Ever Filed	Checkbox	Check this box if an immigrant petition has never been filed for you.
Immigrant Visa Applicant
No	Checkbox	Check this box if you are not an applicant for an immigrant visa.
Yes	Checkbox	Check this box if you are an applicant for an immigrant visa.
Interpreter's Certification and Signature
PDF417BarCode1	Text	This field contains a barcode that encodes specific information about the form and its version.
Language of Interpretation	Text	Enter the language in which you are fluent and used to interpret the application for the applicant.
Interpreter's Signature	Text	Provide the interpreter's signature certifying the interpretation and the applicant's understanding of the application.
Interpreter's Signature Date	Date	Enter the date on which the interpreter signed the certification.
Interpreter's Contact Information
Interpreter's Email Address	Text	Enter the interpreter's email address, if available.
Interpreter's Daytime Telephone Number	Text	Enter the telephone number where the interpreter can be reached during the day. Max length: 10 characters
Interpreter's Mobile Telephone Number	Text	Enter the interpreter's mobile telephone number, if available. Max length: 10 characters
Interpreter's Full Name
Interpreter's Family Name	Text	Enter the interpreter's family name or last name.
Interpreter's Given Name	Text	Enter the interpreter's given name or first name.
Interpreter's Business or Organization Name	Text	Enter the name of the interpreter's business or organization, if applicable. Max length: 34 characters
J-1 Exchange Visitor or J-2 Dependent Status
Yes — J-1 Exchange Visitor or J-2 Dependent Status	Checkbox	Check this box if you currently are or have ever been a J-1 exchange visitor or a J-2 dependent of a J-1 exchange visitor.
No — J-1 Exchange Visitor or J-2 Dependent Status	Checkbox	Check this box if you have never been a J-1 exchange visitor or a J-2 dependent of a J-1 exchange visitor.
Killing Any Person
Killing any person? — No	Checkbox	Check this box if you have never ordered, incited, called for, committed, assisted, helped with, or otherwise participated in killing any person.
Killing any person? — Yes	Checkbox	Check this box if you have ever ordered, incited, called for, committed, assisted, helped with, or otherwise participated in killing any person.
Limiting Religious Beliefs
Limiting or denying ability to exercise religious beliefs — Yes	Checkbox	Check this box if you have ever ordered, incited, called for, committed, assisted, helped with, or otherwise participated in limiting or denying any person's ability to exercise religious beliefs.
Limiting or denying ability to exercise religious beliefs — No	Checkbox	Check this box if you have never ordered, incited, called for, committed, assisted, helped with, or otherwise participated in limiting or denying any person's ability to exercise religious beliefs.
Mailing Address Same as Physical Address
No	Checkbox	Check this box if your mailing address is different from your physical address.
Yes	Checkbox	Check this box if your mailing address is the same as your physical address.
Military or Armed Group Service
Yes — Military or Armed Group Service	Checkbox	Check this box if you have ever served in, been a member of, assisted, or participated in any military, paramilitary, police, self-defense, vigilante, rebel, guerrilla, militia, insurgent, or other armed group.
No — Military or Armed Group Service	Checkbox	Check this box if you have never served in, been a member of, assisted, or participated in any military, paramilitary, police, self-defense, vigilante, rebel, guerrilla, militia, insurgent, or other armed group.
Most Recent United States Entry Information
Date of Last Arrival in the United States	Date	Enter the date you most recently arrived in the United States.
Form I-94 Arrival-Departure Record Number	Text	Enter the record number from your most recent Form I-94 Arrival-Departure Record. Max length: 11 characters
Passport Number	Text	Enter the passport number you used for your most recent entry into the United States, if applicable. Max length: 30 characters
Travel Document Number	Text	Enter the number of the travel document you used for your most recent entry, if applicable. Max length: 30 characters
Passport or Travel Document Issuing Country	Text	Enter the country that issued your passport or travel document.
Passport or Travel Document Expiration Date	Date	Enter the expiration date of your passport or travel document.
Nonconsensual Sexual Contact
No — Nonconsensual sexual contact or relations	Checkbox	Check this box if you have never ordered, incited, called for, committed, assisted, helped with, or otherwise participated in sexual contact or relations with someone who did not consent, was unable to consent, or was being forced or threatened.
Yes — Nonconsensual sexual contact or relations	Checkbox	Check this box if you have ever ordered, incited, called for, committed, assisted, helped with, or otherwise participated in sexual contact or relations with someone who did not consent, was unable to consent, or was being forced or threatened.
Nonimmigrant Status Violation
Yes — Violated terms of nonimmigrant status	Checkbox	Check this box if you have ever violated the terms of the nonimmigrant status you currently hold.
No — Violated terms of nonimmigrant status	Checkbox	Check this box if you have never violated the terms of the nonimmigrant status you currently hold.
Part 3. Processing Information
Processing Information Additional Response	Text	Enter the requested processing information response in this field.
No	Checkbox	Check this box if this application is not based on an extension or change of status that was already granted to your spouse, child, or parent.
Yes	Checkbox	Check this box if this application is based on an extension or change of status that was already granted to your spouse, child, or parent.
Requested Status Extension End Date	Date	Enter the date through which you request that your current or requested status be extended.
Pending Petition Beneficiary or Applicant Information
Beneficiary or Applicant First Name	Text	Enter the first name of the beneficiary or applicant named in the pending petition or application. Fill only if 'Yes, filed previously and pending with USCIS' is 'Yes'. Depends on: Yes, filed previously and pending with USCIS
Petition or Application Date Filed	Date	Enter the date the pending petition or application was filed with USCIS. Fill only if 'Yes, filed previously and pending with USCIS' is 'Yes'. Depends on: Yes, filed previously and pending with USCIS
Beneficiary or Applicant Last Name	Text	Enter the last name of the beneficiary or applicant named in the pending petition or application. Fill only if 'Yes, filed previously and pending with USCIS' is 'Yes'. Depends on: Yes, filed previously and pending with USCIS
Personal Identity Information
Date of Birth	Date	Enter your date of birth.
Country of Citizenship or Nationality	Text	Enter the country of which you are a citizen or national.
Country of Birth	Text	Enter the country where you were born.
U.S. Social Security Number	Text	Enter your U.S. Social Security number, if you have one. Max length: 9 characters
Physical Address Abroad
Street Number and Name	Text	Enter the street number and street name for your physical address abroad. Max length: 34 characters
Apt.	Checkbox	Check this box if the physical address abroad includes an apartment number.
Ste.	Checkbox	Check this box if the physical address abroad includes a suite number.
Flr.	Checkbox	Check this box if the physical address abroad includes a floor number.
Apartment, Suite, or Floor Number	Text	Enter the apartment, suite, or floor number for your physical address abroad, if applicable.
City or Town	Text	Enter the city or town of your physical address abroad. Max length: 28 characters
Province	Text	Enter the province, state, region, or equivalent subdivision for your physical address abroad. Max length: 20 characters
Postal Code	Text	Enter the postal code for your physical address abroad. Max length: 9 characters
Country	Text	Enter the country where your physical address is located. Max length: 41 characters
Preparer's Certification and Signature
Preparer's Certification Signature	Text	Enter the preparer's signature to certify that they prepared the application at the applicant's request and that the information is complete, true, and correct.
Preparer's Signature	Text	Enter the preparer's signature to certify that they prepared the application at the applicant's request and that the information is complete, true, and correct. Max length: 1 characters
Date of Signature	Date	Enter the date on which the preparer signed the certification.
Preparer's Contact Information
Preparer's Email Address	Text	Enter the preparer's email address, if applicable.
Preparer's Daytime Telephone Number	Text	Enter the preparer's daytime telephone number. Max length: 10 characters
Preparer's Mobile Telephone Number	Text	Enter the preparer's mobile telephone number, if applicable. Max length: 10 characters
Preparer's Full Name
Preparer's Family Name	Text	Enter the preparer's family name or last name.
Preparer's Given Name	Text	Enter the preparer's given name or first name.
Preparer's Business or Organization Name	Text	Enter the name of the business or organization the preparer represents, if applicable. Max length: 34 characters
Previously Filed Form I-485
No — Previously Filed Form I-485	Checkbox	Check this box if you have never previously filed Form I-485, Application to Register Permanent Residence or Adjust Status.
Yes — Previously Filed Form I-485	Checkbox	Check this box if you have ever previously filed Form I-485, Application to Register Permanent Residence or Adjust Status.
Related Petition Form Type
Form I-539, Application to Extend/Change Nonimmigrant Status	Checkbox	Check this box if the related petition or application is Form I-539, Application to Extend/Change Nonimmigrant Status. Fill only if 'Yes, filed with this Form I-539', 'Yes, filed previously and pending with USCIS' is 'Yes' for any fields selection. Depends on: Yes, filed with this Form I-539, Yes, filed previously and pending with USCIS
Form I-129, Petition for a Nonimmigrant Worker	Checkbox	Check this box if the related petition or application is Form I-129, Petition for a Nonimmigrant Worker. Fill only if 'Yes, filed with this Form I-539', 'Yes, filed previously and pending with USCIS' is 'Yes' for any fields selection. Depends on: Yes, filed with this Form I-539, Yes, filed previously and pending with USCIS
Removal Proceedings
Removal Proceedings — Yes	Checkbox	Check this box if you are currently in removal proceedings.
Removal Proceedings — No	Checkbox	Check this box if you are not currently in removal proceedings.
Requested Status Change Details
Requested Change Effective Date	Date	Enter the date on which you want the requested change to take effect. Fill only if 'Change of status' is 'Yes'. Depends on: Change of status
Requested Status or Information Change	Combobox	Enter the immigration status, employer, or information medium you are requesting to change to. Fill only if 'Change of status' is 'Yes'. J2S A3 A1 T3 B1D CH U4 V3 B1 5 G4 U2 V1 H4 V2 C1 WB 1 N8 T4 K3 F1 T1 C2 B1C N5 N6 TD E2C G2 A2 G5 9 N4 3 F2 CW1 10 CW2 I T2 G1 J1S M1 WT N2 G3 J1 M2 N1 C4 U3 C3 U1 U5 N7 N3 P4 B1A B1B 2 6 K4 B2 4 N9 O3 T5 R2 J2 Depends on: Change of status
School and SEVIS Information
School Name	Text	Enter the name of the school you will attend as an academic student, vocational student, or exchange visitor.
SEVIS ID Number	Text	Enter your Student and Exchange Visitor Information System (SEVIS) ID number, if applicable. Max length: 30 characters
Second Additional Information Entry
Second Entry Page Number	Text	Enter the page number of the application page to which this second additional information entry refers. Max length: 2 characters
Second Entry Part Number	Text	Enter the part number of the application section to which this second additional information entry refers. Max length: 6 characters
Second Entry Item Number	Text	Enter the item number of the application question or field to which this second additional information entry refers. Max length: 6 characters
Second Additional Information	Text	Provide the additional information that relates to the specified page, part, and item number. Fill only if 'Are you currently or have you EVER been a J-1 exchange visitor or a J-2 dependent of a J-1 exchange visitor?' is 'Yes'. Depends on: Yes — J-1 Exchange Visitor or J-2 Dependent Status
Separate Petition or Application Status
No	Checkbox	Check this box if this application is not based on a separate petition or application for your spouse, child, or parent.
Yes, filed with this Form I-539	Checkbox	Check this box if the separate petition or application for your spouse, child, or parent was filed together with this Form I-539.
Yes, filed previously and pending with USCIS	Checkbox	Check this box if the separate petition or application was filed previously and is still pending with U.S. Citizenship and Immigration Services (USCIS).
Severe Intentional Injury of a Person
No — Intentionally and severely injuring any person	Checkbox	Check this box if you have never ordered, incited, called for, committed, assisted, helped with, or otherwise participated in intentionally and severely injuring any person.
Yes — Intentionally and severely injuring any person	Checkbox	Check this box if you have ever ordered, incited, called for, committed, assisted, helped with, or otherwise participated in intentionally and severely injuring any person.
Third Additional Information Entry
Page Number	Text	Enter the page number of the application page to which this additional information refers. Max length: 2 characters
Part Number	Text	Enter the part number of the application section to which this additional information refers. Max length: 6 characters
Item Number	Text	Enter the item number of the application question or item to which this additional information refers. Max length: 6 characters
Additional Information	Text	Provide the additional information that relates to the specified page, part, and item number. Fill only if 'Are you currently or have you EVER been a J-1 exchange visitor or a J-2 dependent of a J-1 exchange visitor?' is 'Yes'. Depends on: Yes — J-1 Exchange Visitor or J-2 Dependent Status
Torture or Genocide Participation
Acts involving torture or genocide — No	Checkbox	Check this box if you have never ordered, incited, called for, committed, assisted, helped with, or otherwise participated in acts involving torture or genocide.
Acts involving torture or genocide — Yes	Checkbox	Check this box if you have ever ordered, incited, called for, committed, assisted, helped with, or otherwise participated in acts involving torture or genocide.
U.S. Mailing Address
In Care Of Name	Text	Enter the name of the person or organization receiving mail at this address, if applicable. Max length: 34 characters
Street Number and Name	Text	Enter the street number and street name for your U.S. mailing address. Max length: 34 characters
Apt.	Checkbox	Check this box if your U.S. mailing address includes an apartment number, then enter the apartment number.
Ste.	Checkbox	Check this box if your U.S. mailing address includes a suite number, then enter the suite number.
Flr.	Checkbox	Check this box if your U.S. mailing address includes a floor number, then enter the floor number.
Apartment, Suite, or Floor Number	Text	Enter the apartment, suite, or floor number for your U.S. mailing address, if applicable. Max length: 6 characters
City or Town	Text	Enter the city or town for your U.S. mailing address. Max length: 28 characters
State	Combobox	Enter the U.S. state or territory for your mailing address. ID PA NH NY GA SD CA VA ND AA VT WV RI MD OK IN MH LA AE GU AZ MN OH NV VI NM DE MS PR NJ WA MO MT MI PW KS CO MA KY TX NC NE ME UT IA AP FL AR MP TN AK DC AL FM CT OR SC WI HI WY IL AS
ZIP Code	Text	Enter the ZIP Code for your U.S. mailing address. Max length: 5 characters
United States Employment Since Last Admission
No — Employed in the United States Since Last Admission	Checkbox	Check this box if you have not been employed in the United States since you were last admitted or granted an extension or change of status.
Yes — Employed in the United States Since Last Admission	Checkbox	Check this box if you have ever been employed in the United States since you were last admitted or granted an extension or change of status.
Unlabeled Footer Field
Footer Field	Text	Enter the information requested for this unlabeled field in the form footer.
Footer Field	Text	Enter the value required in the form footer.
USCIS Receipt Number
USCIS Receipt Number	Text	Enter the USCIS receipt number for the related petition or application. Fill only if 'Yes, filed with this Form I-539', 'Yes, filed previously and pending with USCIS' is 'Yes' for any fields selection. Max length: 13 characters Depends on: Yes, filed with this Form I-539, Yes, filed previously and pending with USCIS
Weapon Sales or Transportation
Yes	Checkbox	Check this box if you have ever sold, provided, or transported weapons, or assisted someone in doing so, knowing or believing the weapons would be used against another person.
No	Checkbox	Check this box if you have never sold, provided, or transported weapons, or assisted someone in doing so, knowing or believing the weapons would be used against another person.
Weapon Use Group Participation
Yes	Checkbox	Check this box if you have ever been a member of, assisted, or participated in a group, unit, or organization in which you or others used or threatened to use a weapon against any person.
No	Checkbox	Check this box if you have never been a member of, assisted, or participated in such a group, unit, or organization.
Weapons or Paramilitary Training
Yes — Received weapons or paramilitary training	Checkbox	Check this box if you have ever received weapons training, paramilitary training, or any other military-type training.
No — Received weapons or paramilitary training	Checkbox	Check this box if you have never received weapons training, paramilitary training, or any other military-type training.

Form I-539, Application to Extend/Change Nonimmigrant Status Instructions