91°µÍø

Go to the “Forms and Document Downloads” tab at to . Note: you may not file this application online and must download the form.

Follow the instructions provided below when filling out Form I-765 to apply for Severe Economic Hardship Work Authorization.  

Instructions for Completing Form I-765

Type and print; do not use handwriting unless instructed below. If you do handwrite, use black ink. Complete the following fields:

Part 1: Reason for Applying

Page 1

• 1a: Put a checkmark or ‘x’ in the box for“Initial permission to accept employment.”
• 1b: Leave this field blank.
• 1c: Leave this field blank.

Part 2: Information About You

Page 1

• 1a: Provide your family name(s) (last name) as listed on your passport.
• 1.b: Provide your given name(s) (first name) as listed on your passport.
• 1.c: Provide your middle name as listed on your passport, if applicable.
• 2.a. - 4.c: Provide information only if applicable. You only need to enter names you’ve used in an official capacity, such as in classes or on a form. You do not need to submit nicknames. If you have not used any other names, leave these fields blank.

Page 2

• 5.a. - 5.f: This is the address to which your correspondence from USCIS and, if approved, your Employment Authorization Document (EAD) will be sent. The address that you use should be valid for up to four months after you submit your application so that you are able to receive your documents without issues. 

If you will not be at your current address for at least four months, you may use a friend’s/relative's address or the *ISSS Address. If you use the ISSS address, please enter:

• 5.a: In Care of Name: ISSS, 91°µÍø
• 5.b: Street Number and Name: 531 E.Spring St.
• 5.d: City or Town: Oxford
• 5.e: State: OH
• 5.f: Zip Code: 45056

*Note: If you choose to apply for a Social Security Number (SSN) as part of your Severe Economic Hardship application (see fields 14-17 on page 2), you are not able to use the ISSS address.

• 6: Choose the applicable answer.
• 7.a. -7.d: Provide your U.S. physical address, if different than your mailing address.
• 8: Leave this field blank, unless applicable. Most international students do not have an A-number. However, if you previously received an employment authorization document from USCIS, this may be listed as the “USCIS#” on the front of the card.
• 9: Leave this field blank, unless applicable. Most international students do not have a USCIS Online Account Number, unless you have submitted an online application via the USCIS Portal in the past, in which case you may find your USCIS Online Account Number by .
• 10: Your answer should match your passport.
• 11: Indicate your marital status.
• 12: Answer appropriately regarding any previous filings of the I-765 form.
• 13.a: Check ‘yes’ if you have been issued a Social Security card, even if you no longer have it. Check ‘no’ if you have not been issued a Social Security card.
• 13.b: Provide your U.S. social security number if you have one. If you do not, leave this field blank.
• 14: If you do not have a Social Security Number or have lost your SSN card and would like the Social Security Administration to issue you a Social Security card, check ‘yes’ and continue on to Question 15. If not, you can check ‘no’ and then skip to Part 2, Number 18.a.
  • Note: you should not request a Social Security card if you have already been issued one, unless you have lost it.
• 15 - 17.b: Only answer these questions if you selected ‘yes’ for Question 14. If you answered ‘no’ for Question 14, leave 15 - 17.b blank.
  • 15: If you would like to authorize the disclosure of the information from your OPT application to the Social Security Administration, check ‘yes.’ If not, check ‘no.’ Note that if you check ‘yes’ to Question 14, you will need to check ‘yes’ to this question to disclose your information.
  • 16.a - 16.b: Provide your father’s family name/last name and given name/first name as it was when they were born.
  • 17.a - 17.b: Provide your mother’s family name/last name and given name/first name as it was when they were born.
• 18.a - 18.b: Indicate any countries where you are currently a citizen or national.  If you are a citizen or national of more than two countries, ISSS can help you properly document the remaining country or countries in Part 6.

Page 3

• 19.a - 19.c: Provide information about your place of birth. If your country does not have States or Provinces, you may leave 19.b. blank.
• 20: Enter your date of birth in month, date, year format.
• 21.a: Enter your 11-digit “Admission I-94 Record Number” from your .
• 21.b: Enter your passport number.
• 21.c: If you have a travel document, rather than a passport, provide your travel document number. If you already indicated your passport number in 21.b, leave this field blank.
• 21.d: List the country that issued your passport or travel document (Note - it may differ from the country you were in when you got your passport if you applied from a consulate or embassy outside your home country.)
• 21.e: Enter the expiration date of your passport or travel document
• 22: Provide the “Arrival/Issued Date” from your to confirm when you last entered the U.S.
• 23: Enter the city where you went through U.S. Customs.  Note, the city may not be in the U.S. Check your  to confirm. You may write out the full name of the city or enter the airport code listed on your Travel History record.
• 24: Generally your status at your last entry to the U.S. should be “F-1 Student.” If that has changed, please consult with ISSS.
• 25: Enter F-1 Student.
• 26: Provide your SEVIS number from your most recently-issued I-20, which starts with the letter “N” and is located on the top right-hand side of your I-20.  The form has already provided the “N” so just enter the number.
• 27: The eligibility code for Severe Economic Hardship work authorization is ( c ) ( 3 ) ( iii )
• 28 - 31.b: Leave these fields blank. 

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

Page 4

• 1.a. - 2: Put an “X” in the appropriate box.
• 3 - 5: Provide your current contact information.
• 6: Leave this field blank unless it applies to you.
• 7.a. - 7.b: Sign and date your application form. Signature must be in ink.  No digital or electronic signatures will be accepted.

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

Pages 4 - 5

• 1.a. - 7.b: Leave these fields blank unless an interpreter assisted you with the form. Staff from the ISSS office are not considered interpreters.

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

Pages 5 - 6

• 1.a. - 8.b: Leave these fields blank unless a preparer assisted you with the form. Staff from the ISSS office are not considered preparers.

Part 6: Additional Information

Page 7: leave this page blank.  If you need to provide Additional Information, an ISSS advisor will help you complete this page.