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SAMPLE LETTER TO USCIS

DATE

U.S. Department of Homeland Security


U.S. Citizenship and Immigration Services
2200 Potomac Center Dr Stop 2425
Arlington, VA 20598-2425

Re: I-765 Withdrawal


YSC1990247512
(DOUBLE CHECK THE TOP LEFT-HAND CORNER OF
YOUR I-797 RECEIPT NOTICE TO MAKE SURE THAT THE
NUMBER IS CORRECT)
Dear Officer:

My name is Leonardo Solano Moraga. I submitted a Form I-765 application to apply for
Optional Practical Training. My USCIS Receipt Number is YSC1234567890
and my SEVIS ID Number is N0004588514.

I have decided to withdraw my pending OPT application. Provide reason: I have


decided not to continue with my pending pre-completion OPT application.

I have attached a copy of my I-797 Receipt Notice for your reference.

Sincerely,

(signature)

TYPED NAME
ADDRESS in the United States