[Today’s Date]

[Your name and address]

USCIS [office where you filed]

Subject: Notification of application withdrawal

I-765 Application for Employment Authorization [Your Petition Form Number and Type]

Petitioner: [Your name]

Beneficiary: [Name]

Dear Sir/Madam,

USCIS Receipt number: [Receipt number]

Purpose: Withdraw the application.

Reason: [Do not need work authorization now.] - Reason is mandatory to provide.

Date of Application Submission: [Date]

My contact details:

Address: [Your Address]

Phone: [phone number]

Email: [your email].

Thank you,

[Your Signature] - Should match the one on application.

[Your Name]


  1. Copy of the USCIS receipt notice.

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