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 2003 2003
2004
2005
2006
2007
2008
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 2003 2003
2004
2005
2006
2007
2008
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 2003 2003
2004
2005
2006
2007
2008
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 2003 2003
2004
2005
2006
2007
2008
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 2003 2003
2004
2005
2006
2007
2008
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 2003 2003
2004
2005
2006
2007
2008
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 2003 2003
2004
2005
2006
2007
2008
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 2003 2003
2004
2005
2006
2007
2008
Check here if you are still outside the U.S.