Physical
Presence Test:
Day
Month
Year
Enter date you left U.S.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
January
February
March
April
May
June
July
August
September
October
November
December
before 1996
1996
1997
1998
1999
2000
Enter date you returned to the U.S.
(check box below if still outside
U.S.)
N/A
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
N/A
January
February
March
April
May
June
July
August
September
October
November
December
N/A
before 1996
1996
1997
1998
1999
2000
Date you left U.S. again
N/A
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
N/A
January
February
March
April
May
June
July
August
September
October
November
December
N/A
before 1996
1996
1997
1998
1999
2000
Date you returned to the U.S. again
(check box below if still outside
U.S.)
N/A
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
N/A
January
February
March
April
May
June
July
August
September
October
November
December
N/A
before 1996
1996
1997
1998
1999
2000
Date you left the U.S. for the third time
N/A
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
N/A
January
February
March
April
May
June
July
August
September
October
November
December
N/A
before 1996
1996
1997
1998
1999
2000
Dates you returned to the U.S. for the third time
(check box below if still outside
U.S.)
N/A
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
N/A
January
February
March
April
May
June
July
August
September
October
November
December
N/A
before 1996
1996
1997
1998
1999
2000
Date you left the U.S. for the fourth time
N/A
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
N/A
January
February
March
April
May
June
July
August
September
October
November
December
N/A
before 1996
1996
1997
1998
1999
2000
Date you returned to the U.S. for the fourth time
(check box below if still outside
U.S.)
N/A
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
N/A
January
February
March
April
May
June
July
August
September
October
November
December
N/A
before 1996
1996
1997
1998
1999
2000