Have you previously filed Form I-765?

✓ Check No if you have not previously applied for work authorization with an I-765

✓ Check Yes if you have previously filed an I-765 (provide evidence)

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?

➢ When and where you were born

✓ What is your city, town or village of birth?

✓ What is your state or province of birth?

✓ What is your country of birth?

✓ What is your date of birth?

➢ Your immigration information

✓ What is your country of citizenship or nationality?

✓ What is your Form I-94 Arrival-Departure Record Number?

When did you last arrive in the United States?

Date of Arrival

Place of arrival (airport)

Status at last arrival

Select F-1 unless you changed your status after your most recent arrival

✓ What is the passport number of your most recently issued passport?

What is your travel document number (if any)? In most cases, leave this section blank. Likely you don't have one.

✓ What is the expiration date of your passport or travel document?

✓ What country issued your passport or travel document?