OMB No. 1615-0003: Expires 12/31/2015 Department of Homeland Security U.S. Citizenship and Immigration Services I-539, Application to Extend/ Change Nonimmigrant Status START HERE - Please type or print in blue or black ink Part 1. Information About You Family Name (Last Name) Given Name (First Name) Middle Name Address - In care of - Street Number and Name City State Zip Code Daytime Phone Number Country of Birth Country of Citizenship Date of Birth (mmedd/yyyy) U. S. Social Security # (if any) A-Number (if any) Date of Last Arrival Into the U.S. 05/22/2013 94 Number NA Current Nonimmigrant Status B-2 Expires on ( nnilddiyyyy) 06/02/2013 Part 2. Application Type (See instructions for fee) 1. I am applying for: (Check one) a X An extension of stay in my current status. b. A change of status. The new status I am requesting is: Reinstatement to student status. Apt. Number c. K 2. Number of people included in this application: (Check one) a. El I am the only applicant. b. El Members of my family are filing this application with me. The total number of people (including me) in the application is: (Complete the supplement for each co-applicant.) Part 3. Processing Information 1. I/We request that my/our current or requested status be extended until (mm/dd/yyyy): 10/2 0/2 013 2. Is this application based on an extension or change of status already granted to your spouse, child, or parent? NI No K Yes. USCIS Receipt # 3. iTthis application based on a separate petition or application to give your spouse, child, or parent an extension or change of status?El No K Yes, filed with this I-539. K Place under docket control For USCIS (Ice Only Returned Date Resubmitted Date Reloc Sent Date Reloc Recd Date Applicant Interviewed on Date Receipt Extension Granted to (Date): Change of Status/Ectension Granted New Class: From (Date): To (Date): If Denied: K Still within period of stay K S/D to: K