Is someone assisting you with completing this application?
Is a preparer assisting you with completing this application?
Is an interpreter assisting you with completing this application?
Preparer information
What is your preparer’s full name?
Given name (first name)
Family name (last name)
What is your preparer’s business or organization name?
What is your preparer’s contact information?
Daytime telephone number
Mobile telephone number
Email address
Interpreter information
What is your interpreter’s full name?
Given name (first name)
Family name (last name)
What is your interpreter’s business or organization name?
What is your interpreter’s contact information?
Daytime telephone number
Mobile telephone number
Email address
What language is your interpreter using to interpret this application for you?
About You
Your name
What is your current legal name?
Given name (first name)
Middle name
Family name (last name)
Has used additional names
Have you used any other names since birth?
Your contact information
How may we contact you?
Daytime telephone number
Mobile telephone number (if any)
Email address
What is your current mailing address or safe address?
In care of name (if any)
Address line 1
Address line 2
City or town
State
ZIP code
Is your current mailing address the same as your physical address?
What is your current physical address?
Address line 1
Address line 2
City or town
State
ZIP code
How long have you lived at this address?
From date
To date
When and where you were born
What is your date of birth?
What is your city or town of birth?
What is your country of birth?
What is your country of citizenship or nationality?
Your address history
Your address history
Your immigration information
When did you last arrive in the United States?
Date of arrival
Place of arrival
Immigration status at last arrival
Date immigration status expires/expired
What is your Form I-94 Arrival-Departure Record Number?
What is the expiration date of Authorized Stay shown on your Form 1-94? (if any)
Since entry, in what activities have you been engaged?
In what activities do you intend to engage between now and your expected date of departure?
How long do you expect to remain in the United States?
What is your expected date of departure?
Other information
What is your A-Number?
What is your USCIS Online Account Number?
Describe yourself
What is your sex?
What is your ethnicity?
What is your race?
What is your height?
Feet
Inches
What is your weight?
What is the color of your eyes?
What is the color of your hair?
Police and criminal record
Have you EVER been arrested, cited, charged, or permitted to participate in a diversion program (including pre-trial diversion, deferred prosecution, deferred adjudication, or any withheld adjudication), or detained for any reason by any law enforcement official in any country including but not limited to any U.S. immigration official or any official of the U.S. armed forces or U.S. Coast Guard or by a similar official of a country other than the United States?
Have you EVER committed a crime If any kind (even if you were not arrested, cited, charged with, or tried for that crime, or convicted)?
Have you EVER pled guilty to or been convicted of a crime or offense (even if the violation was subsequently expunged or sealed by a court, or if you were granted a pardon, amnesty, a rehabilitation decree, or other act of clemency)?
Have you EVER been ordered punished by a judge or had conditions imposed on you that restrained your liberty (such as a prison sentence, suspended sentence, house arrest, parole, alternative sentencing, drug or alcohol treatment, rehabilitative programs or classes, probation, or community service)?
Have you EVER violated (or attempted or conspired to violate) any controlled substance law or reguation of a state, the United States, or a foreign country?
Your Family
Your current husband or wife
Are you currently married?
What is your husband or wife’s current legal name?
Given name (first name)
Family name (last name)
What is your husband or wife’s date of birth?
What is your husband or wife’s city of birth?
What is your husband or wife’s country of birth?
When did you marry your husband or wife?
Where were you married?
City or Town
State or Province
Country
Your father
What is your father’s name?
Given name (first name)
Family name (last name)
What is your father’s date of birth?
What is your father’s city or town of birth? (if known)
What is your father’s country of birth? (if known)
What is your father’s current city or town of residence? (if living)
What is your father’s current country of residence? (if living)
Your mother
What is your mother’s name?
Given name (first name)
Family name (last name)
What is your mother’s date of birth?
What is your mother’s city or town of birth? (if known)
What is your mother’s country of birth? (if known)
What is your mother’s current city or town of residence? (if living) What is your mother’s current country of residence? (if living)
