These questions not apply to ‘c 3 C’ applicants—leave checkboxes blank, write “N/A” or “none” in response fields.

Part 3: Applicant's Statement, Contact Information, Declaration, Certification and Signature:

Part 3: Item 7.a.: Applicant's Signature

Your signature must be handwritten in black ink (not typed) and fit inside the box. Signatures that fit will be scanned and printed on your EAD card. If the signature is too big, your application could be delayed.

Part 4: Interpreter's Contact Information, Certification and Signature

Complete all fields with “N/A”, unless an interpreter read and explained every question and instruction to you.

Part 5: Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant

Complete all fields with “N/A”, unless another person completed this form on your behalf.

See the following page, Instructions for Part 6, for detailed instructions.

Reminder: Include ALL pages of the Form I-765, even pages that do not apply to you, when you submit your application to USCIS for adjudication.

Part 6: Additional Information

Part 6: Item 1-2: Additional Information

Complete this section only if:

• You do not have enough room to sufficiently answer any of the items contained in Parts 1-5
• You have been approved for CPT in the past
• You have been approved for OPT in the past
• You have used a different SEVIS ID in F-1 status in the U.S. (for example, you attended school for a while, left the U.S. to take a break from school, and returned with a new I