Form I-765, Application for Employment Authorization Instructions
This form contains 170 fields organized into 58 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Additional Info Applicant Identifiers | ||
| Family Name (Last Name) | Text |
Type or print your family (last) name as it appears on your supporting documents.
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| Given Name (First Name) | Text |
Type or print your given (first) name as it appears on your supporting documents.
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| Middle Name | Text |
Type or print your middle name as it appears on your supporting documents.
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| A-Number (if any) | Text |
Type or print your Alien Registration Number (A-Number), starting with 'A', if any.
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| Additional Info Fifth Continuation Row | ||
| Additional Info Fifth Continuation Row Page Number | Text |
Enter the page number of the application form to which this additional information refers.
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| Additional Info Fifth Continuation Row Part Number | Text |
Enter the part number of the application form to which this additional information refers.
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| Additional Info Fifth Continuation Row Item Number | Text |
Enter the item number of the application form to which this additional information refers.
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| Additional Info Fifth Continuation Row Details | Text |
Provide the detailed additional information corresponding to the referenced page, part, and item numbers.
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| Additional Info First Continuation Row | ||
| First Continuation Row Page Number | Text |
Enter the page number of this additional information continuation row.
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| First Continuation Row Part Number | Text |
Enter the part number of this additional information continuation row.
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| First Continuation Row Item Number | Text |
Enter the item number of this additional information continuation row.
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| First Continuation Row Additional Information | Text |
Provide the additional information corresponding to the page, part, and item numbers indicated above.
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| Additional Info Fourth Continuation Row | ||
| Fourth Continuation Row Page Number | Number |
Enter the page number of the form to which this continuation entry’s additional information refers.
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| Fourth Continuation Row Part Number | Text |
Enter the part number of the form to which this continuation entry’s additional information refers.
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| Fourth Continuation Row Item Number | Text |
Enter the item number of the form to which this continuation entry’s additional information refers.
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| Fourth Continuation Row Additional Information | Text |
Provide the additional information corresponding to the referenced page, part, and item number in this space.
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| Additional Info Second Continuation Row | ||
| Second Continuation Row Page Number | Text |
Enter the page number of the application that your additional information refers to.
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| Second Continuation Row Part Number | Text |
Enter the part number of the form that your additional information refers to.
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| Second Continuation Row Item Number | Text |
Enter the item number of the form that your additional information refers to.
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| Second Continuation Row Additional Information | Text |
Provide the additional information corresponding to the referenced page, part, and item numbers.
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| Additional Info Sheet Footer Field | ||
| Additional Information Sheet Sequence Number | Text |
Enter the sequential number of this additional information sheet.
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| Additional Info Third Continuation Row | ||
| 3rd Continuation Page Number | Text |
Enter the page number of the third continuation sheet where your additional information appears.
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| 3rd Continuation Part Number | Text |
Enter the part number of Form I-765 to which the third continuation sheet information refers.
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| 3rd Continuation Item Number | Text |
Enter the item number on Form I-765 that the third continuation sheet information addresses.
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| 3rd Continuation Additional Information | Text |
Provide the detailed additional information for the referenced page, part, and item on the third continuation sheet.
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| Applicant Full Legal Name | ||
| Family Name (Last Name) | Text |
Enter your full legal family name (last name) exactly as it appears on your official documents.
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| Given Name (First Name) | Text |
Enter your full legal given name (first name) exactly as it appears on your official documents.
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| Middle Name | Text |
Enter your full legal middle name exactly as it appears on your official documents, or leave this field blank if you do not have a middle name.
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| Applicant's Contact Information | ||
| Daytime Telephone Number | Text |
Provide the telephone number where USCIS can reach you during daytime hours.
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| Mobile Telephone Number | Text |
Provide your mobile telephone number, if any, where USCIS can contact you.
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| Email Address | Text |
Provide your email address, if any, where USCIS can contact you.
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| ABC Settlement Agreement Eligibility | Checkbox |
Check this box if you are a Salvadoran or Guatemalan national eligible for benefits under the ABC settlement agreement.
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| Applicant's Signature | ||
| Date of Signature | Date |
Enter the date on which you signed the application.
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| Applicant's Signature | Text |
Provide your handwritten signature as it should appear on the application.
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| Applicant's Statement Selections | ||
| 1.b. Interpreter read questions and instructions | Checkbox |
Select this box if the interpreter named in Part 4 read to you every question and instruction on this application and your answer to every question in a language you are fluent in and you understood everything.
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| 1.a. I can read and understand English | Checkbox |
Select this box if you can read and understand English, and you have read and understand every question and instruction on this application and your answer to every question.
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| Interpreter’s Language (Item 1.b.) | Text |
Enter the language in which the interpreter named in Part 4 read every question and instruction on this application in which you are fluent. Fill only if the 'Item Number 1.b.' is 'Yes'.
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| 2. Preparer prepared application based on your information | Checkbox |
Select this box if, at your request, the preparer named in Part 5 prepared this application for you based only upon information you provided or authorized.
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| Preparer’s Name (Item 2) | Text |
Provide the full name of the preparer named in Part 5 who prepared this application at your request using only information you provided or authorized. Fill only if the 'Item Number 2' is 'Yes'.
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| Arrival Document Numbers | ||
| Travel Document Number | Text |
Enter the number of your travel document, if any.
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| Expiration Date of Passport or Travel Document | Date |
Enter the expiration date of your passport or travel document.
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| Country That Issued Your Passport or Travel Document | Text |
Enter the name of the country that issued your passport or travel document.
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| Passport Number of Most Recently Issued Passport | Text |
Enter the number from your most recently issued passport.
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| Form I-94 Arrival-Departure Record Number | Text |
Enter the most recent I-94 Arrival-Departure record number issued for your last arrival to the United States, if available.
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| Asylum Pending Arrest Checkbox | ||
| Yes | Checkbox |
Check this box if you have ever been arrested for and/or convicted of any crime. Fill only if the 'Eligibility Category' is 'c(8)'.
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| No | Checkbox |
Check this box if you have never been arrested for or convicted of any crime. Fill only if the 'Eligibility Category' is 'c(8)'.
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| Attorney Representation Extent | ||
| Representation extends beyond preparation of this application | Checkbox |
Check this box if you are an attorney or accredited representative and your representation extends beyond the preparation of this application. Fill only if the 'I am an attorney or accredited representative' is 'Yes'.
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| Representation does not extend beyond preparation of this application | Checkbox |
Check this box if you are an attorney or accredited representative and your representation does not extend beyond the preparation of this application. Fill only if the 'I am an attorney or accredited representative' is 'Yes'.
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| Attorney/Representative USCIS Online Account Number | ||
| Attorney or Accredited Representative USCIS Online Account Number | Text |
Enter the USCIS Online Account Number for the attorney or accredited representative assisting with this application. Fill only if the 'Select this box if Form G-28 is attached' is 'Yes'.
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| Birth Information | ||
| Date of Birth | Date |
Provide your date of birth in mm/dd/yyyy format.
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| Country of Birth | Text |
Enter the country where you were born.
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| City/Town/Village of Birth | Text |
Enter the name of the city, town, or village where you were born.
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| State/Province of Birth | Text |
Enter the state or province where you were born.
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| Consent for Disclosure to SSA (Yes/No) | ||
| Consent for Disclosure to SSA – No | CheckBox |
Check this box if you do not authorize disclosure of information from this application to the SSA as required for assigning you a Social Security number and issuing you a Social Security card. Fill only if the 'Do you want the SSA to issue you a Social Security card?' is 'Yes'.
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| Consent for Disclosure to SSA – Yes | CheckBox |
Check this box if you authorize disclosure of information from this application to the SSA as required for assigning you a Social Security number and issuing you a Social Security card. Fill only if the 'Do you want the SSA to issue you a Social Security card?' is 'Yes'.
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| Countries of Citizenship/Nationality | ||
| Second Country of Citizenship or Nationality | Text |
Enter the name of the second country where you are currently a citizen or national; if you need more space, use Part 6 Additional Information for additional entries.
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| First Country of Citizenship or Nationality | Text |
Enter the name of the first country where you are currently a citizen or national.
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| Current Status and SEVIS | ||
| Current Immigration Status or Category | Text |
Enter your current U.S. immigration status or category (for example, B-2 visitor, F-1 student, parolee, deferred action, or no status or category).
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| SEVIS Number | Text |
Enter your Student and Exchange Visitor Information System (SEVIS) number, including the “N-” prefix, if you have one.
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| Eligibility Category Code | ||
| Eligibility Category Code – Part 1 | Text |
Enter the first element of your eligibility category code (the letter component) as found in the Form I-765 Who May File instructions.
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| Eligibility Category Code – Part 2 | Text |
Enter the second element of your eligibility category code (the number component) as found in the Form I-765 Who May File instructions.
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| Eligibility Category Code – Part 3 | Text |
Enter the third element of your eligibility category code (the subcategory component) as found in the Form I-765 Who May File instructions, if applicable.
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| Father's Birth Name | ||
| Father's Birth Family Name | Text |
Enter your father's family name (last name) at birth.
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| Father's Birth Given Name | Text |
Enter your father's given name (first name) at birth.
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| First Other Name Used | ||
| First Other Last Name | Text |
Enter the applicant’s family name (last name) for the first other name used.
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| First Other First Name | Text |
Enter the applicant’s given name (first name) for the first other name used.
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| First Other Middle Name | Text |
Enter the applicant’s middle name for the first other name used.
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| Footer Additional Field | ||
| Page Number | Number |
Enter the current page number of this form.
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| Footer Continuation Field | ||
| Footer Continuation | Text |
Enter the identifier or text used in the form’s footer to indicate that content continues onto the next page.
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| Form Footer Internal Control | ||
| Form internal control number | Text |
Enter the unique internal control number printed in the form’s footer.
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| G-28 Attached Checkbox | ||
| Form G-28 attached | CheckBox |
Check this box if you have attached Form G-28 to this application.
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| H-4 Receipt Number (c)(26) | ||
| H-4 Receipt Number | Text |
Enter the receipt number from your H-1B spouse’s most recent Form I-797 Notice for Form I-129. Fill only if the 'Eligibility Category' is '(c)(26)'.
Depends on:
Eligibility Category Code – Part 1, Eligibility Category Code – Part 2
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| I-140 Arrest Checkbox | ||
| Ever arrested or convicted of any crime – Yes | Checkbox |
Check this box if you have been arrested for and/or convicted of any crime.
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| Ever arrested or convicted of any crime – No | Checkbox |
Check this box if you have never been arrested for or convicted of any crime.
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| I-140 Receipt Number (c)(35)/(c)(36) | ||
| I-140 Receipt Number | Text |
Provide the receipt number from the Form I-797 Notice for Form I-140 Immigrant Petition for Alien Worker under eligibility category (c)(35), or your spouse’s/parent’s Form I-797 receipt number under category (c)(36). Fill only if the 'Eligibility Category' is '(c)(35)' or '(c)(36)'.
Depends on:
Eligibility Category Code – Part 1, Eligibility Category Code – Part 2
|
| Identification Numbers (A-Number & USCIS Online Account) | ||
| Alien Registration Number (A-Number) | Text |
Enter the USCIS-issued Alien Registration Number (A-Number) assigned to you, if you have one.
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| USCIS Online Account Number | Text |
Enter your USCIS Online Account Number provided when you created your online USCIS account, if you have one.
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| Interpreter Certification Language | ||
| Interpreter’s Certification Language | Text |
Enter the language, other than English, in which the interpreter is fluent and read every question and instruction to the applicant, matching the language specified in Part 3, Item 1.b.
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| Interpreter Contact Information | ||
| Interpreter’s Daytime Telephone Number | Text |
Enter the interpreter’s daytime telephone number, including area code.
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| Interpreter’s Email Address | Text |
Enter the interpreter’s email address, if any.
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| Interpreter’s Mobile Telephone Number | Text |
Enter the interpreter’s mobile telephone number, if any.
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| Interpreter Mailing Address | ||
| City or Town | Text |
Enter the city or town for the interpreter’s mailing address.
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| Street Number and Name | Text |
Enter the street number and name for the interpreter’s mailing address.
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| Flr. | Checkbox |
Check this box if the interpreter’s mailing address includes a floor number.
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| Apt. | Checkbox |
Check this box if the interpreter’s mailing address includes an apartment number.
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| Apartment, Suite, or Floor Number | Text |
Enter the apartment, suite, or floor number for the interpreter’s mailing address if applicable.
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| Ste. | Checkbox |
Check this box if the interpreter’s mailing address includes a suite number.
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| Postal Code | Text |
Enter the postal code for the interpreter’s mailing address (for addresses outside the United States).
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| ZIP Code | Text |
Enter the ZIP Code for the interpreter’s mailing address (for addresses within the United States).
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| State | Combobox |
Enter the U.S. state abbreviation for the interpreter’s mailing address.
AA
CA
DE
FM
NM
VI
KY
WI
NV
TX
MH
AS
PA
SD
OK
NC
OR
HI
ME
UT
IL
OH
ID
VT
IN
AZ
KS
AE
MI
GA
FL
ND
NJ
PR
WV
AR
PW
IA
MO
WY
NY
VA
SC
AK
AL
NE
LA
MN
GU
CO
MA
AP
TN
MP
MD
CT
MT
WA
DC
MS
RI
NH
|
| Country | Text |
Enter the country name for the interpreter’s mailing address (for addresses outside the United States).
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| Province | Text |
Enter the province, territory, or region for the interpreter’s mailing address (for addresses outside the United States).
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| Interpreter Signature and Date | ||
| Date of Interpreter’s Signature | Date |
Enter the date the interpreter signed the form.
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| Interpreter’s Signature | Text |
Enter the interpreter’s handwritten signature to certify the translation.
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| Interpreter's Full Name | ||
| Interpreter's Business or Organization Name | Text |
Enter the name of the interpreter’s business or organization, if any.
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| Interpreter's Given Name (First Name) | Text |
Enter the given name (first name) of the interpreter as it appears on their legal or official documents.
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| Interpreter's Family Name (Last Name) | Text |
Enter the family name (last name) of the interpreter as it appears on their legal or official documents.
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| Last Arrival Details | ||
| Date of Last Arrival | Date |
Enter the date of your most recent arrival into the United States.
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| Immigration Status at Last Arrival | Text |
Provide your immigration status at the time of your most recent arrival into the United States (for example, B-2 visitor, F-1 student, or no status).
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| Place of Last Arrival | Text |
Provide the city, state, or other location where you last entered the United States.
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| Mailing Address Same as Physical (Yes/No) | ||
| Mailing address same as physical address – No | CheckBox |
Check this box if your current mailing address is not the same as your physical address.
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| Mailing address same as physical address – Yes | CheckBox |
Check this box if your current mailing address is the same as your physical address.
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| Marital Status | ||
| Widowed | CheckBox |
Check this box if your marital status is widowed.
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| Divorced | CheckBox |
Check this box if your marital status is divorced.
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| Single | CheckBox |
Check this box if your marital status is single.
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| Married | CheckBox |
Check this box if your marital status is married.
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| Mother's Birth Name | ||
| Mother's Family Name (Last Name) | Text |
Enter your mother's family name (last name) at birth exactly as shown on her birth certificate.
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| Mother's Given Name (First Name) | Text |
Enter your mother's given name (first name) at birth exactly as shown on her birth certificate.
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| Page Footer Field | ||
| Page Footer Text | Text |
Enter the text that will appear in the footer at the bottom of this form page.
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| Page Number Field | ||
| Page Number | Text |
Enter the page number for this page of the form.
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| Preparer Contact Information | ||
| Preparer’s Mobile Telephone Number | Text |
Enter the preparer’s mobile telephone number, including area code, if any.
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| Preparer’s Daytime Telephone Number | Text |
Enter the preparer’s daytime telephone number, including area code.
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| Preparer’s Email Address | Text |
Enter the preparer’s email address, if any.
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| Preparer Full Name | ||
| Preparer's Given Name | Text |
Enter the legal first name of the person preparing this application exactly as it appears on official documents.
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| Preparer's Business or Organization Name | Text |
Provide the name of the business or organization for which the preparer works, if any; otherwise leave this field blank.
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| Preparer's Family Name | Text |
Enter the legal last name of the person preparing this application exactly as it appears on official documents.
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| Preparer Mailing Address | ||
| Preparer Mailing Address City or Town | Text |
Enter the city or town for the preparer's mailing address.
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| Preparer Mailing Address Street Number and Name | Text |
Enter the street number and street name for the preparer's mailing address.
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| Preparer's Mailing Address – Flr. | Checkbox |
Check this box if the preparer's mailing address includes a floor number.
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| Preparer's Mailing Address – Apt. | Checkbox |
Check this box if the preparer's mailing address includes an apartment number.
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| Preparer Mailing Address Apartment, Suite, or Floor | Text |
If applicable, enter the apartment, suite, or floor number for the preparer's mailing address.
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| Preparer's Mailing Address – Ste. | Checkbox |
Check this box if the preparer's mailing address includes a suite number.
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| Preparer Mailing Address Postal Code | Text |
Enter the postal code for the preparer's mailing address.
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| Preparer Mailing Address ZIP Code | Text |
Enter the U.S. ZIP Code for the preparer's mailing address.
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| Preparer Mailing Address State | Combobox |
Enter the two-letter U.S. state abbreviation for the preparer's mailing address.
AA
CA
DE
FM
NM
VI
KY
WI
NV
TX
MH
AS
PA
SD
OK
NC
OR
HI
ME
UT
IL
OH
ID
VT
IN
AZ
KS
AE
MI
GA
FL
ND
NJ
PR
WV
AR
PW
IA
MO
WY
NY
VA
SC
AK
AL
NE
LA
MN
GU
CO
MA
AP
TN
MP
MD
CT
MT
WA
DC
MS
RI
NH
|
| Preparer Mailing Address Country | Text |
Enter the country name for the preparer's mailing address.
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| Preparer Mailing Address Province | Text |
Enter the province or region for the preparer's mailing address if outside the United States.
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| Preparer Signature and Date | ||
| Preparer's Signature | Text |
Enter the signature of the person preparing this application.
|
| Date of Signature | Date |
Enter the date the preparer signed the application in mm/dd/yyyy format.
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| Preparer Statement Selection | ||
| I am not an attorney or accredited representative and have prepared this application on behalf of the applicant with the applicant’s consent | Checkbox |
Check this box if you are not an attorney or accredited representative and have prepared this application on behalf of the applicant with the applicant’s consent.
|
| I am an attorney or accredited representative and my representation of the applicant in this case extends or does not extend beyond the preparation of this application | Checkbox |
Check this box if you are an attorney or accredited representative and represent the applicant in this case.
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| Previously Filed Form I-765 (Yes/No) | ||
| Previously Filed Form I-765 – No | CheckBox |
Check this box if you have not previously filed Form I-765.
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| Previously Filed Form I-765 – Yes | CheckBox |
Check this box if you have previously filed Form I-765.
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| Reason for Applying Selection | ||
| Initial permission to accept employment | CheckBox |
Check this box if you are applying for initial permission to accept employment.
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| Replacement of lost, stolen, or damaged employment authorization document, or correction not due to USCIS error | CheckBox |
Check this box if you are applying for a replacement of a lost, stolen, or damaged employment authorization document, or a correction not due to a USCIS error.
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| Renewal of permission to accept employment | CheckBox |
Check this box if you are applying for renewal of your permission to accept employment and attach a copy of your previous employment authorization document.
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| Request SSA to Issue Social Security Card (Yes/No) | ||
| Request SSA to issue a Social Security card – No | CheckBox |
Check this box if you do not want the SSA to issue you a Social Security card.
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| Request SSA to issue a Social Security card – Yes | CheckBox |
Check this box if you want the SSA to issue you a Social Security card.
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| Second Other Name Used | ||
| Second Other Name Used – Family Name | Text |
Provide the family name (last name) you have used as a second other name.
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| Second Other Name Used – Given Name | Text |
Provide the given name (first name) you have used as a second other name.
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| Second Other Name Used – Middle Name | Text |
Provide the middle name you have used as a second other name.
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| Sex | ||
| Female | CheckBox |
Check this box if you are female.
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| Male | CheckBox |
Check this box if you are male.
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| Social Security Number | ||
| Social Security Number | Text |
Enter your nine-digit Social Security Number (SSN) issued by the Social Security Administration, if known.
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| SSA Previously Issued Social Security Card (Yes/No) | ||
| No | CheckBox |
Check this box if the Social Security Administration (SSA) has never officially issued a Social Security card to you.
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| Yes | CheckBox |
Check this box if the Social Security Administration (SSA) has ever officially issued a Social Security card to you.
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| STEM OPT Employer Details | ||
| Employer’s Name as Listed in E-Verify | Text |
Enter the employer’s name exactly as it appears in the E-Verify system. Fill only if the 'Eligibility Category' is '(c)(3)(C)'.
Depends on:
Eligibility Category Code – Part 1, Eligibility Category Code – Part 2, Eligibility Category Code – Part 3
|
| Employer’s E-Verify Company Identification Number | Text |
Enter the employer’s E-Verify Company Identification Number or a valid E-Verify client company identification number. Fill only if the 'Eligibility Category' is '(c)(3)(C)'.
Depends on:
Eligibility Category Code – Part 1, Eligibility Category Code – Part 2, Eligibility Category Code – Part 3
|
| Degree | Text |
Enter the academic degree you obtained that qualifies you for the STEM OPT extension. Fill only if the 'Eligibility Category' is '(c)(3)(C)'.
Depends on:
Eligibility Category Code – Part 1, Eligibility Category Code – Part 2, Eligibility Category Code – Part 3
|
| Third Other Name Used | ||
| Third Other Name Used Middle Name | Text |
Enter the middle name of the third other name you have ever used.
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| Third Other Name Used Given Name | Text |
Enter the given name (first name) of the third other name you have ever used.
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| Third Other Name Used Family Name | Text |
Enter the family name (last name) of the third other name you have ever used.
|
| U.S. Mailing Address | ||
| Part 2. Information About You. Your U.S. Mailing Address. 5. C. Select Suite | CheckBox |
Check this box if the unit type for your U.S. mailing address is a Suite (for example, Suite 200). Select only one unit-type box (Apartment, Suite, or Floor).
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| Part 2. Information About You. Your U.S. Mailing Address. 5. C. Select Designated Floor | CheckBox |
Check this box if the unit type for your U.S. mailing address is a specific Floor (for example, Floor 3). Select only one unit-type box (Apartment, Suite, or Floor).
|
| Apartment, Suite, or Floor Number | Text |
If applicable, enter your apartment, suite, or floor number for your U.S. mailing address.
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| Part 2. Information About You. Your U.S. Mailing Address. 5. C. Select Apartment | CheckBox |
Check this box if the unit type for your U.S. mailing address is an Apartment (for example, Apt 4B). Select only one unit-type box (Apartment, Suite, or Floor).
|
| City or Town | Text |
Enter the city or town of your U.S. mailing address.
|
| State | ComboBox |
Enter the two-letter U.S. state abbreviation of your U.S. mailing address.
AA
CA
DE
FM
NM
VI
KY
WI
NV
TX
MH
AS
PA
SD
OK
NC
OR
HI
ME
UT
IL
OH
ID
VT
IN
AZ
KS
AE
MI
GA
FL
ND
NJ
PR
WV
AR
PW
IA
MO
WY
NY
VA
SC
AK
AL
NE
LA
MN
GU
CO
MA
AP
TN
MP
MD
CT
MT
WA
DC
MS
RI
NH
|
| ZIP Code | Text |
Enter the five-digit ZIP Code of your U.S. mailing address.
|
| Street Number and Name | Text |
Provide the street number and street name of your U.S. mailing address.
|
| In Care Of Name | Text |
Enter the name of the person or entity to receive mail on your behalf, if applicable.
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| U.S. Physical Address | ||
| Ste. | CheckBox |
Check this box if your U.S. physical address includes a suite number.
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| Flr. | CheckBox |
Check this box if your U.S. physical address includes a floor number.
|
| Apt./Ste./Flr. Number | Text |
If applicable, enter your apartment, suite, or floor number for your U.S. physical address. Fill only if the 'Is your current mailing address the same as your physical address?' is 'No'.
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| Apt. | CheckBox |
Check this box if your U.S. physical address includes an apartment number.
|
| City or Town | Text |
Enter the city or town of your U.S. physical address. Fill only if the 'Is your current mailing address the same as your physical address?' is 'No'.
|
| State | ComboBox |
Enter the two-letter U.S. state abbreviation for your U.S. physical address. Fill only if the 'Is your current mailing address the same as your physical address?' is 'No'.
AA
CA
DE
FM
NM
VI
KY
WI
NV
TX
MH
AS
PA
SD
OK
NC
OR
HI
ME
UT
IL
OH
ID
VT
IN
AZ
KS
AE
MI
GA
FL
ND
NJ
PR
WV
AR
PW
IA
MO
WY
NY
VA
SC
AK
AL
NE
LA
MN
GU
CO
MA
AP
TN
MP
MD
CT
MT
WA
DC
MS
RI
NH
|
| ZIP Code | Text |
Enter the five-digit ZIP Code of your U.S. physical address. Fill only if the 'Is your current mailing address the same as your physical address?' is 'No'.
|
| Street Number and Name | Text |
Enter the street number and name of your U.S. physical address. Fill only if the 'Is your current mailing address the same as your physical address?' is 'No'.
|
| USCIS 2D Barcode | ||
| USCIS 2D Barcode | Text |
Enter the USCIS two-dimensional (2D) barcode data printed or generated for this application.
|