Form I-539 - Application To Extend/change Nonimmigrant Status Page 6

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If you answered "Yes" to Item Number 19. in Part 4. of this
Part 4. (continued) Additional Information for
form, fully describe the employment. Include the name of the
Answers to Item Numbers 18., 19., and 20.
person employed, name and address of the employer, weekly
income, and whether the employment was specifically
If you answered "Yes" to Item Number 18. in Part 4. of this
authorized by USCIS.
form, give the following information concerning the removal
proceedings. Include the name of the person in removal
3.
proceedings and information on jurisdiction, date proceedings
began, and status of proceedings.
1.
If you answered "Yes" to Item Number 20. in Part 4. of this
form, list the name and dates of the person or persons who
maintained status as a J-1 exchange visitor or J-2 dependent.
If you answered "No" to Item Number 19. in Part 4. of this
4.
form, fully describe how you are supporting yourself. Include
the source, amount, and basis for any income.
2.
Form I-539 12/23/16 N
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