NOTE: Provide all other names you have ever used, including aliases, maiden name, and nicknames.
If you need extra space to complete this section, use the Addtional Information box given below.
Looks good!
Please enter a family name.
Looks good!
Please enter a given name.
Looks good!
Please enter a middle name if applicable.
Looks good!
Please enter a family name.
Looks good!
Please enter a given name.
Looks good!
Please enter a middle name if applicable.
Looks good!
Please enter a family name.
Looks good!
Please enter a given name.
Looks good!
Please enter a middle name if applicable.
Looks good!
Please enter any additional name information.
Your U.S Mailing Address
Looks good!
Please enter the “In Care Of†name if applicable.
Looks good!
Please enter your street number and name.
Looks good!
Please select apartment/suite/floor, if applicable.
Looks good!
Please enter your apartment/suite/floor number, if applicable.
Please enter a valid A-Number (up to 9 digits) or leave
blank if not applicable.
Leave blank if not applicable.
Looks good!
Please enter USCIS ONline Account Number or leave blank if not
applicable.
6. Sex
Marital Status
Have you previously filed Form I-765?
Looks good!
Please enter Social Security Number or leave blank if not
applicable.
Your Country or Countries of Citizenship or Nationality
List all countries where you are currently a citizen or national.
Looks good!
Please enter your country of citizenship or nationality.
Looks good!
Please enter your second country of citizenship or nationality if applicable.
If you need extra space to complete this item, use the given space below:
Looks good!
Please enter any additional citizenship or nationality information.
Place of Birth
List the city/town/village, state/province, and country where you were born.
Looks good!
Please enter your city/town/village of birth.
Looks good!
Please enter your state/province of birth.
Looks good!
Please enter your country of birth.
Looks good!
Please enter your date of birth.
Information About Your Last Arrival in the United States
Looks good!
Please enter a valid I-94 number (up to 11 characters).
Looks good!
Please enter your passport number.
Looks good!
Please enter your travel document number if applicable.
Looks good!
Please enter the country that issued your passport or travel document.
Looks good!
Please enter the expiration date.
Looks good!
Please enter your last arrival date.
Looks good!
Please enter the place of your last arrival.
Looks good!
Please enter your immigration status at your last arrival.
Looks good!
Please enter your current immigration status or category.
N-
Looks good!
Please enter your SEVIS number if applicable.
Information About Your Eligibility Category
Refer to the Who May File Form I-765 section of the Form I-765
Instructions to determine the appropriate eligibility category for this application.
Enter the appropriate letter and number for your eligibility category below
(for example, (a)(8), (c)(17)(iii)).
()()()
Looks good!
Please enter your eligibility category.
28. (c)(3)(C) STEM OPT Eligibility Category
If you entered the eligibility category (c)(3)(C) in
Item Number 27, provide the information requested in Item Numbers
28.a - 28.c.
Looks good!
Please enter your degree information.
Looks good!
Please enter the employer name listed in E-Verify.
Looks good!
Please enter the E-Verify company identification number.
29. (c)(26) Eligibility Category
If you entered the eligibility category (c)(26) in Item Number 27,
provide the receipt number of your H-1B spouse's most recent Form I-797
Notice for Form I-129, Petition for a Nonimmigrant Worker.
Looks good!
Please enter a valid I-797 receipt number.
30. (c)(8) Eligibility Category
If you entered the eligibility category (c)(8) in Item Number 27,
have you EVER been arrested for and/or convicted of any crime?
Looks good!
Please select an option.
NOTE:
If you answered “Yes†to Item Number 30, refer to
Special Filing Instructions for Those With Pending Asylum Applications
(c)(8) in the Required Documentation section of the Form I-765
Instructions for information about providing court dispositions.
31.a. (c)(35) and (c)(36) Eligibility Category
If you entered the eligibility category (c)(35) in Item Number 27,
please provide the receipt number of your Form I-797 Notice for
Form I-140, Immigrant Petition for Alien Worker.
If you entered the eligibility category (c)(36) in Item Number 27,
please provide the receipt number of your spouse's or parent's
Form I-797 Notice for Form I-140.
Looks good!
Please enter a valid I-797 receipt number.
31.b. If you entered the eligibility category (c)(35) or (c)(36)
in Item Number 27, have you EVER been arrested for and/or convicted
of any crime?
Looks good!
Please select an option.
NOTE:
If you answered “Yes†to Item Number 31.b, refer to
Employment-Based Nonimmigrant Categories, Items 8.-9.
in the Who May File Form I-765 section of the Form I-765 Instructions
for information about providing court dispositions.