Basis of eligibility

✓ What is your degree?

■ List your STEM eligible major and degree level

✓ What is your employer's name as listed in E-Verify?

■ List your employer's name

✓ What is your employer's E-Verify company identification number or a valid E-Verify client company identification number?

■ List the 5 - 7 digit number here. Note that this IS NOT the same thing as the Employer Identification (EIN) number that is required on the Form I-983.

✓ Reason for applying

Check initial permission to accept employment (as this is your first time applying for category C3C)

Have you previously filed Form I-765

Check Yes

■ Preparer and interpreter information

Is someone assisting you with completing this application:

Check No

➢ Your Name

✓ What is your current legal name?

✓ Have you used any other names since birth?

➢ Your contact information

✓ How may we contact you?

Daytime telephone number

Email address

■ What is your current U.S. mailing address?

Is your current mailing address the same as your physical address?

Describe yourself

■ What is your gender?

■ What is your marital status?