Form I-360, Petition for Amerasian, Widow(er), or Special Immigrant Instructions
This form contains 510 fields organized into 72 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Abuser Information | ||
| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 1. Full Name of U.S. citizen or Lawful Permanent Resident Abuser. Enter Middle Name | Text |
Enter the middle name of the U.S. citizen or lawful permanent resident who is your abuser. This field is required if you are filing as a VAWA self-petitioning spouse, child, or parent.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 1. Full Name of U.S. citizen or Lawful Permanent Resident Abuser. Enter Given Name (First Name) | Text |
Enter the given name (first name) of the U.S. citizen or lawful permanent resident who is your abuser. This field is required if you are filing as a VAWA self-petitioning spouse, child, or parent.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. NOTE: For the safety and protection of all V. A. W. A. self-petitioners, information regarding a filing will only be provided to the self-petitioner or their designated attorney or representative with a valid Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative. 1. Full Name of U.S. citizen or Lawful Permanent Resident Abuser. Enter Family Name (Last Name) | Text |
Enter the family name (last name) of the U.S. citizen or lawful permanent resident who is your abuser. This field is required if you are filing as a VAWA self-petitioning spouse, child, or parent.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 5. Your abuser is now, or was, a (Select one). D. U.S. Lawful Permanent Resident. 1. Provide. A. Number (if any) | Text |
If your abuser is or was a U.S. lawful permanent resident, provide their Alien Number (A-Number). This field is required if you are filing as a VAWA self-petitioning spouse, child, or parent.
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| Abuser's Status | ||
| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 5. Your abuser is now, or was, a (Select one). E. Other (Explain). Enter Explanation | Text |
Provide an explanation if your abuser's status does not fit into the predefined categories (U.S. citizen born in the United States, U.S. citizen born abroad to U.S. citizen parents, U.S. citizen through naturalization, or U.S. Lawful Permanent Resident).
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 5. Your abuser is now, or was, a (Select one). A. Select U.S. citizen born in the United States | CheckBox |
Select this option if your abuser is or was a U.S. citizen born in the United States.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 5. Your abuser is now, or was, a (Select one). B. Select U.S. citizen born abroad to U.S. citizen parents | CheckBox |
Select this option if your abuser is or was a U.S. citizen born abroad to U.S. citizen parents.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 5. Your abuser is now, or was, a (Select one). C. Select U.S. citizen through naturalization | CheckBox |
Select this option if your abuser is or was a U.S. citizen through naturalization.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 5. Your abuser is now, or was, a (Select one). D. Select U.S. Lawful Permanent Resident | CheckBox |
Select this option if your abuser is or was a U.S. Lawful Permanent Resident.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 5. Your abuser is now, or was, a (Select one). E. Select Other (Explain) | CheckBox |
Select this option if your abuser's status is not listed and provide an explanation in the text field provided.
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| Additional Information | ||
| Part 15. Additional Information. 5. D. Enter Additional Information | Text |
Enter any additional information relevant to the petition.
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| Part 15. Additional Information. 2. Enter Alien Registration Number (A. Number), if any | Text |
Enter the Alien Registration Number (A-Number) if available.
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| Part 15. Additional Information. 3. A. Enter Page Number | Number |
Enter the page number where additional information is provided.
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| Part 15. Additional Information. 3. B. Enter Part Number | Text |
Enter the part number where additional information is provided.
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| Part 15. Additional Information. 3. C. Enter Item Number | Text |
Enter the item number where additional information is provided.
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| Part 15. Additional Information. 3. D. Enter Additional Information | Text |
Enter any additional information relevant to the specific part and item number.
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| Part 15. Additional Information. 6. A. Enter Page Number | Number |
Enter the page number where additional information is provided.
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| Part 15. Additional Information. 6. B. Enter Part Number | Text |
Enter the part number from the form that corresponds to the additional information you are providing.
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| Part 15. Additional Information. 6. C. Enter Item Number | Text |
Enter the item number from the form that corresponds to the additional information you are providing.
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| Part 15. Additional Information. 6. D. Enter Additional Information | Text |
Provide any additional information that corresponds to the part and item numbers you have specified.
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| Part 15. Additional Information. 5. C. Enter Item Number | Text |
Enter the item number from the form that corresponds to the additional information you are providing.
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| Part 15. Additional Information. 5. B. Enter Part Number | Text |
Enter the part number from the form that corresponds to the additional information you are providing.
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| Part 15. Additional Information. 5. A. Enter Page Number | Number |
Enter the page number from the form that corresponds to the additional information you are providing.
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| Part 15. Additional Information. 4. A. Enter Page Number | Number |
Enter the page number from the form that corresponds to the additional information you are providing.
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| Part 15. Additional Information. 4. B. Enter Part Number | Text |
Enter the part number from the form that corresponds to the additional information you are providing.
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| Part 15. Additional Information. 4. C. Enter Item Number | Text |
Enter the item number from the form that corresponds to the additional information you are providing.
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| Part 15. Additional Information. 4. D. Enter Additional Information | Text |
Provide any additional information that corresponds to the part and item numbers you have specified.
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| Part 15. Additional Information. 1. Enter Middle Name | Text |
Enter the middle name of the individual for whom additional information is being provided.
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| Address Information | ||
| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 10. Provide the last address at which you lived together with your abuser. Enter Street Number and Name | Text |
Enter the street number and name of the last address where you lived together with your abuser.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 10. Provide the last address at which you lived together with your abuser. Select Suite | CheckBox |
Select this checkbox if the last address where you lived together with your abuser was a suite.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 10. Provide the last address at which you lived together with your abuser. Select Apartment | CheckBox |
Select this checkbox if the last address where you lived together with your abuser was an apartment.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 10. Provide the last address at which you lived together with your abuser. Select Floor | CheckBox |
Select this checkbox if the last address where you lived together with your abuser was on a specific floor.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 10. Provide the last address at which you lived together with your abuser. Enter Apartment, Suite or Floor Number | Text |
Enter the apartment, suite, or floor number of the last address where you lived together with your abuser.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 10. Provide the last address at which you lived together with your abuser. Enter City or Town | Text |
Enter the city or town of the last address where you lived together with your abuser.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 10. Provide the last address at which you lived together with your abuser. Select State from List of States | ComboBox |
Select the state from the list where you last lived together with your abuser.
OR
DE
UT
AZ
GA
NV
SD
MS
TX
IA
CA
WA
WY
FL
AE
WV
PA
AR
MD
NH
NC
AS
AA
ID
MA
DC
KS
MO
NY
LA
WI
AL
GU
MH
MN
AP
CT
NM
NJ
PR
IN
VA
FM
RI
OH
OK
HI
MT
VT
SC
MP
TN
CO
ME
ND
VI
KY
MI
AK
IL
PW
NE
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 10. Provide the last address at which you lived together with your abuser. Enter Zip Code | Text |
Enter the ZIP code of the last address where you lived together with your abuser. The ZIP code should be 5 digits long.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 10. Provide the last address at which you lived together with your abuser. Enter Postal Code | Text |
Enter the postal code of the last address where you lived together with your abuser. The postal code can be up to 9 digits long.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 10. Provide the last address at which you lived together with your abuser. Enter Province | Text |
Enter the province of the last address where you lived together with your abuser. The province name can be up to 20 characters long.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 10. Provide the last address at which you lived together with your abuser. Enter Country | Text |
Enter the country of the last address where you lived together with your abuser.
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| Alternate Mailing Address | ||
| Part 1. Information About Person or Organization Filing This Petition. 7. Alternate and / or Safe Mailing Address. If you are a V. A. W. A. self-petitioning spouse, child, parent, or a special immigrant juvenile and do not want U.S. Citizenship and Immigration Services (U S C I S) to send notices about this petition to your home, you may provide an alternate and / or safe mailing address. Enter In Care Of Name (if any) | Text |
Enter the 'In Care Of' name for an alternate and/or safe mailing address. This is used if the petitioner does not want USCIS to send notices to their home address.
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| Part 1. Information About Person or Organization Filing This Petition. 7. Alternate and / or Safe Mailing Address. Enter Street Number and Name | Text |
Enter the street number and name for an alternate and/or safe mailing address. This is used if the petitioner does not want USCIS to send notices to their home address.
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| Part 1. Information About Person or Organization Filing This Petition. 7. Alternate and / or Safe Mailing Address. Select Suite | CheckBox |
Select this box if the alternate and/or safe mailing address includes a suite number.
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| Part 1. Information About Person or Organization Filing This Petition. 7. Alternate and / or Safe Mailing Address. Select Apartment | CheckBox |
Select this box if the alternate and/or safe mailing address includes an apartment number.
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| Part 1. Information About Person or Organization Filing This Petition. 7. Alternate and / or Safe Mailing Address. Select Floor | CheckBox |
Select this box if the alternate and/or safe mailing address includes a floor number.
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| Amerasian Information | ||
| Part 6. Complete Only If Filing for an Amerasian. Information About the Mother of the Amerasian. 1. Mother's Full Name. Enter Middle Name | Text |
Enter the middle name of the mother of the Amerasian for whom this petition is being filed. This section is only to be completed if filing for an Amerasian.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Mother of the Amerasian. 2. A. Is the mother still alive? Select Yes | CheckBox |
Select this checkbox if the mother of the Amerasian for whom this petition is being filed is still alive.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Mother of the Amerasian. 2. C. If you answered "No" to Item A. in Item Number 2., provide her date of death. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
If the mother of the Amerasian is deceased, enter her date of death in the format MM/DD/YYYY.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. 6. B. If you answered "Yes" to Item A. in Item Number 4., provide his address below. Enter In Care Of Name (If any) | Text |
If the father of the Amerasian is alive and you answered 'Yes' to Item A in Item Number 4, provide his address. Enter the 'In Care Of' name if applicable.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. 6. B. If you answered "Yes" to Item A. in Item Number 4., provide his address below. Enter Street Number and Name | Text |
If the father of the Amerasian is alive and you answered 'Yes' to Item A in Item Number 4, provide his address. Enter the street number and name.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. 6. B. If you answered "Yes" to Item A. in Item Number 4., provide his address below. Select Apartment | CheckBox |
If the father of the Amerasian is alive and you answered 'Yes' to Item A in Item Number 4, select this checkbox if the address includes an apartment.
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| Amerasian Petition | ||
| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. 6. D. Enter Daytime Telephone Number, if any | Text |
Enter the daytime telephone number of the father of the Amerasian, if available.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. At the time the Amerasian was conceived. 7. B. Provide the father's service number | Text |
Provide the service number of the father of the Amerasian at the time the Amerasian was conceived.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. At the time the Amerasian was conceived. 7. A. The father was in the military (indicate branch of service). Select Army | CheckBox |
Select this checkbox if the father of the Amerasian was in the Army at the time the Amerasian was conceived.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. At the time the Amerasian was conceived. 7. A. The father was in the military (indicate branch of service). Select Air Force | CheckBox |
Select this checkbox if the father of the Amerasian was in the Air Force at the time the Amerasian was conceived.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. At the time the Amerasian was conceived. 7. A. The father was in the military (indicate branch of service). Select Navy | CheckBox |
Select this checkbox if the father of the Amerasian was in the Navy at the time the Amerasian was conceived.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. At the time the Amerasian was conceived. 7. A. The father was in the military (indicate branch of service). Select Marine Corps | CheckBox |
Select this checkbox if the father of the Amerasian was in the Marine Corps at the time the Amerasian was conceived.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. At the time the Amerasian was conceived. 7. A. The father was in the military (indicate branch of service). Select Coast Guard | CheckBox |
Select this checkbox if the father of the Amerasian was in the Coast Guard at the time the Amerasian was conceived.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. At the time the Amerasian was conceived. 7. C. Select The father was not in the military and was not a civilian employed abroad. Attach a full explanation of the circumstances | CheckBox |
Select this checkbox if the father of the Amerasian was not in the military and was not a civilian employed abroad at the time the Amerasian was conceived. Attach a full explanation of the circumstances.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. 6. B. If you answered "Yes" to Item A. in Item Number 4., provide his address below. Enter Country | Text |
Enter the country of residence for the father of the Amerasian if you answered 'Yes' to the question about his address.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. 6. A. Is the father still alive? Select Yes | CheckBox |
Select 'Yes' if the father of the Amerasian is still alive.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. 6. A. Is the father still alive? Select No | CheckBox |
Select 'No' if the father of the Amerasian is not alive.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. 6. B. If you answered "Yes" to Item A. in Item Number 4., provide his address below. Select Suite | CheckBox |
Select this option if the address of the father of the Amerasian includes a suite number.
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| Attorney Information | ||
| To be completed by an Attorney or Accredited Representative (if any). Select this box if Form G-28 or G-28 I is attached | CheckBox |
Select this box if Form G-28 or G-28I is attached. This form is used by an attorney or accredited representative to notify USCIS of their representation.
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| To be completed by an attorney or accredited representative (if any). Enter Attorney State Bar Number (if applicable) | Text |
Enter the Attorney State Bar Number if applicable. This is required if an attorney is representing the petitioner.
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| To be completed by an attorney or accredited representative (if any). Enter Attorney or Accredited Representative U S C I S Online Account Number (if any) | Text |
Enter the Attorney or Accredited Representative USCIS Online Account Number, if any. This is used for online account management with USCIS.
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| Authorized Signatory Information | ||
| Part 12. Statement, Contact Information, Declaration, and Signature of the Petitioner or Authorized Signatory. Authorized Signatory's Contact Information. 4. Enter Authorized Signatory's Title | Text |
Enter the title of the authorized signatory who is filling out this form on behalf of the petitioner.
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| Barcode | ||
| PDF417BarCode1 | Text |
This field contains a barcode for the form I-360. No input is required from the user.
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| Classification Requested | ||
| Part 2. Classification Requested. Select only one box. 1. A. Select Amerasian | CheckBox |
Select this checkbox if you are requesting classification as an Amerasian.
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| Part 2. Classification Requested. Select only one box. 1. B. Select Widow(er) of a U.S. citizen | CheckBox |
Select this checkbox if you are requesting classification as a widow(er) of a U.S. citizen.
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| Part 2. Classification Requested. Select only one box. 1. C. Select Special Immigrant Juvenile | CheckBox |
Select this checkbox if you are requesting classification as a Special Immigrant Juvenile.
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| Part 2. Classification Requested. Select only one box. 1. D. Select Special Immigrant Religious Worker | CheckBox |
Select this checkbox if you are requesting classification as a Special Immigrant Religious Worker.
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| Part 2. Classification Requested. Select only one box. 1. E. Select Special Immigrant based on employment with the Panama Canal Company, Canal Zone Government, or U.S. Government in the Canal Zone | CheckBox |
Select this checkbox if you are requesting classification as a Special Immigrant based on employment with the Panama Canal Company, Canal Zone Government, or U.S. Government in the Canal Zone.
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| Part 2. Classification Requested. Select only one box. 1. H. Select Special Immigrant Armed Forces Member | CheckBox |
Select this checkbox if you are requesting classification as a Special Immigrant Armed Forces Member.
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| Part 2. Classification Requested. Select only one box. 1. F. Select Special Immigrant Physician | CheckBox |
Select this checkbox if you are requesting classification as a Special Immigrant Physician.
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| Part 2. Classification Requested. Select only one box. 1. I. Select Self-Petitioning Spouse of Abusive U.S. citizen or Lawful Permanent Resident | CheckBox |
Select this checkbox if you are requesting classification as a Self-Petitioning Spouse of an Abusive U.S. citizen or Lawful Permanent Resident.
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| Part 2. Classification Requested. Select only one box. 1. G. Select Special Immigrant G-4 International Organization Employee or Family Member or NATO-6 Employee or Family Member | CheckBox |
Select this checkbox if you are requesting classification as a Special Immigrant G-4 International Organization Employee or Family Member or NATO-6 Employee or Family Member.
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| Part 2. Classification Requested. Select only one box. 1. L. Select Special Immigrant Afghanistan or Iraq National who worked with the U.S. Armed Forces as a translator | CheckBox |
Select this checkbox if you are requesting classification as a Special Immigrant Afghanistan or Iraq National who worked with the U.S. Armed Forces as a translator.
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| Part 2. Classification Requested. Select only one box. 1. K. Select V. A. W. A. Self-Petitioning Parent of a U.S. citizen son or daughter | CheckBox |
Select this checkbox if you are requesting classification as a VAWA Self-Petitioning Parent of a U.S. citizen son or daughter.
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| Part 2. Classification Requested. Select only one box. 1. J. Select Self-Petitioning Child of Abusive U.S. citizen or Lawful Permanent Resident | CheckBox |
Select this checkbox if you are requesting classification as a Self-Petitioning Child of an Abusive U.S. citizen or Lawful Permanent Resident.
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| Part 2. Classification Requested. Select only one box. 1. P. Select Other | CheckBox |
Select this checkbox if you are requesting classification under a category not listed above.
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| Part 2. Classification Requested. Select only one box. 1. M. Select Special Immigrant Iraq National who was employed by or on behalf of the U.S. Government | CheckBox |
Select this checkbox if you are a Special Immigrant Iraq National who was employed by or on behalf of the U.S. Government.
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| Part 2. Classification Requested. Select only one box. 1. N. Select Special Immigrant Afghanistan National who was employed by or on behalf of the U.S. Government or the International Security Assistance Force (I S. A. F) in Afghanistan | CheckBox |
Select this checkbox if you are a Special Immigrant Afghanistan National who was employed by or on behalf of the U.S. Government or the International Security Assistance Force (ISAF) in Afghanistan.
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| Part 2. Classification Requested. Select only one box. 1. O. Select Broadcasters | CheckBox |
Select this checkbox if you are applying as a Broadcaster.
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| Part 2. Classification Requested. Select only one box. If you selected 1. D. Special Immigrant Religious Worker, answer the following question. 1. Will the beneficiary be working as a minister? Select Yes | CheckBox |
Select 'Yes' if the beneficiary will be working as a minister. This is applicable if you selected 'Special Immigrant Religious Worker' as the classification.
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| Part 2. Classification Requested. Select only one box. If you selected 1. D. Special Immigrant Religious Worker, answer the following question. 1. Will the beneficiary be working as a minister? Select No | CheckBox |
Select 'No' if the beneficiary will not be working as a minister. This is applicable if you selected 'Special Immigrant Religious Worker' as the classification.
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| Part 2. Classification Requested. Select only one box. 1. P. Other. If selected, provide the name of the classification | Text |
If you selected 'Other' as the classification, provide the name of the classification in this text field.
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| Consulate Information | ||
| Part 4. Processing Information. 1. If the person listed in Part 3. is outside the U.S., is ineligible to adjust status in the U.S., or does not wish to adjust status in the U.S., provide the following information about the U.S. Consulate at which the person prefers to apply for an immigrant visa. U.S. Consulate. B. Enter Country | Text |
If the person listed in Part 3 is outside the U.S., ineligible to adjust status in the U.S., or does not wish to adjust status in the U.S., enter the country of the U.S. Consulate where the person prefers to apply for an immigrant visa.
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| Part 4. Processing Information. 1. If the person listed in Part 3. is outside the U.S., is ineligible to adjust status in the U.S., or does not wish to adjust status in the U.S., provide the following information about the U.S. Consulate at which the person prefers to apply for an immigrant visa. U.S. Consulate. A. Enter City or Town | Text |
If the person listed in Part 3 is outside the U.S., ineligible to adjust status in the U.S., or does not wish to adjust status in the U.S., enter the city or town of the U.S. Consulate where the person prefers to apply for an immigrant visa.
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| Contact Information | ||
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Contact Information. 19. Enter Fax Number, if any | Text |
Enter the fax number, if available, for contact purposes. The number should be 10 digits long.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Contact Information. 18. Enter Daytime Telephone Number | Text |
Enter the daytime telephone number for contact purposes. The number should be 10 digits long.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Contact Information. 20. Enter Email Address, if any | Text |
Enter the email address, if available, for contact purposes.
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| Part 12. Statement, Contact Information, Declaration, and Signature of the Petitioner or Authorized Signatory. Authorized Signatory's Contact Information. 6. Enter Authorized Signatory's Mobile Telephone Number, if any | Text |
Enter the mobile telephone number of the authorized signatory, if available. The number should be up to 10 digits long.
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| Part 12. Statement, Contact Information, Declaration, and Signature of the Petitioner or Authorized Signatory. Authorized Signatory's Contact Information. 7. Enter Authorized Signatory's Email Address, if any | Text |
Enter the email address of the authorized signatory, if available.
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| Part 12. Statement, Contact Information, Declaration, and Signature of the Petitioner or Authorized Signatory. Authorized Signatory's Contact Information. 5. Enter Authorized Signatory's Daytime Telephone Number | Text |
Enter the daytime telephone number of the authorized signatory. The number should be up to 10 digits long.
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| Part 12. Statement, Contact Information, Declaration, and Signature of the Petitioner or Authorized Signatory. Authorized Signatory's Contact Information. 3. Enter Authorized Signatory's Family Name (Last Name) | Text |
Enter the family name (last name) of the authorized signatory.
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| Part 12. Statement, Contact Information, Declaration, and Signature of the Petitioner or Authorized Signatory. Authorized Signatory's Contact Information. 3. Enter Authorized Signatory's Given Name (First Name) | Text |
Enter the given name (first name) of the authorized signatory.
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| Employment Details | ||
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 4. Provide a summary of the type of responsibilities of those employees, other than the beneficiary, who work at the same location where the beneficiary will be employed. If you need extra space to complete this section use the space provided in Part 15. Additional Information. Enter Summary of the Type of Responsibilities for That Position | Text |
Provide a summary of the type of responsibilities of employees, other than the beneficiary, who work at the same location where the beneficiary will be employed. Use Part 15 for additional space if needed.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 6. Provide the following information about the prospective employment. If you need extra space to complete this section, use the space provided in Part 15. Additional Information. A. Enter Title of position offered | Text |
Enter the title of the position offered to the beneficiary.
|
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 6. C. Enter a detailed description of the beneficiary's proposed daily duties | Text |
Provide a detailed description of the beneficiary's proposed daily duties.
|
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 6. D. Enter the description of the beneficiary's qualifications for the position offered | Text |
Describe the beneficiary's qualifications for the position offered.
|
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 6. E. Enter the description of the proposed salaried and/or non-salaried compensation | Text |
Enter the description of the proposed salaried and/or non-salaried compensation for the beneficiary.
|
| Employment Location | ||
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 6. F. Provide the specific addresses or locations where the beneficiary will be working. Enter Company Name | Text |
Enter the company name where the beneficiary will be working. Maximum length is 34 characters.
|
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 6. F. Provide the specific addresses or locations where the beneficiary will be working. Enter Street Number and Name | Text |
Enter the street number and name of the location where the beneficiary will be working. Maximum length is 34 characters.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 6. F. Provide the specific addresses or locations where the beneficiary will be working. Select Suite | CheckBox |
Select this checkbox if the location where the beneficiary will be working is a suite.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 6. F. Provide the specific addresses or locations where the beneficiary will be working. Select Apartment | CheckBox |
Select this checkbox if the location where the beneficiary will be working is an apartment.
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| Father's Address | ||
| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. 6. B. If you answered "Yes" to Item A. in Item Number 4., provide his address below. Select Floor | CheckBox |
Select the floor number of the address of the father of the Amerasian if you answered 'Yes' to Item A in Item Number 4.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. 6. B. If you answered "Yes" to Item A. in Item Number 4., provide his address below. Enter Apartment, Suite or Floor Number | Text |
Enter the apartment, suite, or floor number of the address of the father of the Amerasian if you answered 'Yes' to Item A in Item Number 4. Maximum length is 6 characters.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. 6. B. If you answered "Yes" to Item A. in Item Number 4., provide his address below. Enter City or Town | Text |
Enter the city or town of the address of the father of the Amerasian if you answered 'Yes' to Item A in Item Number 4. Maximum length is 20 characters.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. 6. B. If you answered "Yes" to Item A. in Item Number 4., provide his address below. Select State from List of States | ComboBox |
Select the state from the list of states for the address of the father of the Amerasian if you answered 'Yes' to Item A in Item Number 4.
OR
DE
UT
AZ
GA
NV
SD
MS
TX
IA
CA
WA
WY
FL
AE
WV
PA
AR
MD
NH
NC
AS
AA
ID
MA
DC
KS
MO
NY
LA
WI
AL
GU
MH
MN
AP
CT
NM
NJ
PR
IN
VA
FM
RI
OH
OK
HI
MT
VT
SC
MP
TN
CO
ME
ND
VI
KY
MI
AK
IL
PW
NE
|
| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. 6. B. If you answered "Yes" to Item A. in Item Number 4., provide his address below. Enter Zip Code | Text |
Enter the zip code of the address of the father of the Amerasian if you answered 'Yes' to Item A in Item Number 4. Maximum length is 5 characters.
|
| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. 6. B. If you answered "Yes" to Item A. in Item Number 4., provide his address below. Enter Postal Code | Text |
Enter the postal code of the address of the father of the Amerasian if you answered 'Yes' to Item A in Item Number 4. Maximum length is 9 characters.
|
| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. 6. B. If you answered "Yes" to Item A. in Item Number 4., provide his address below. Enter Province | Text |
Enter the province of the address of the father of the Amerasian if you answered 'Yes' to Item A in Item Number 4. Maximum length is 20 characters.
|
| Father's Information | ||
| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. 4. Enter Date of Birth. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
Enter the date of birth of the father of the Amerasian in the format MM/DD/YYYY.
|
| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. 5. Enter Country of Birth | Text |
Enter the country of birth of the father of the Amerasian.
|
| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. 3. Father's Full Name. Enter Middle Name | Text |
Enter the middle name of the father of the Amerasian.
|
| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. 3. Father's Full Name. Enter Given Name (First Name) | Text |
Enter the given name (first name) of the father of the Amerasian.
|
| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. If possible, attach a notarized statement from the father regarding parentage. If there is a question you cannot fully answer in the space provided on this petition, use the space provided in Part 15. Additional Information. 3. Father's Full Name. Enter Family Name (Last Name) | Text |
Enter the family name (last name) of the father of the Amerasian. If possible, attach a notarized statement from the father regarding parentage. Use Part 15 for additional information if needed.
|
| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. 6. A. Is the father still alive? Select Unknown | CheckBox |
Indicate whether the father of the Amerasian is still alive by selecting 'Unknown'.
|
| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. 6. C. If you answered "No" to Item A. in Item Number 4., provide his date of death. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
If the father of the Amerasian is deceased, provide his date of death in the format MM/DD/YYYY.
|
| Part 6. Complete Only If Filing for an Amerasian. Information About the Father of the Amerasian. 6. E. Enter Work Telephone Number, if any | Text |
Enter the work telephone number of the father of the Amerasian, if available. The number should be 10 digits long.
|
| Foreign Address | ||
| Part 4. Processing Information. 2. 2. If a U.S. address was provided in Part 3., type or print the person's foreign address below. If he or she does not maintain a foreign address, list the city or town and country of last foreign residence. If his or her native alphabet does not use Roman letters, type or print his or her name and foreign address in the native alphabet. B. Mailing Address. Enter Street Number and Name | Text |
Enter the street number and name of the foreign address for the person if a U.S. address was provided in Part 3. If no foreign address is maintained, list the city or town and country of last foreign residence. If the native alphabet does not use Roman letters, type or print the name and foreign address in the native alphabet.
|
| Form Identification | ||
| PDF417BarCode1 | Text |
This is a barcode field used for form identification and processing.
|
| PDF417BarCode1 | Text |
This is a barcode field used for form identification and processing. No input required.
|
| PDF417BarCode1 | Text |
This is a barcode field used for form identification and processing.
|
| PDF417BarCode1 | Text |
This is a barcode field used for form identification and processing.
|
| PDF417BarCode1 | Text |
This is a barcode field used for form identification and processing. No input is required.
|
| PDF417BarCode1 | Text |
This is a barcode field used for form identification and processing.
|
| Form Metadata | ||
| PDF417BarCode1 | Text |
This field contains a PDF417 barcode which includes encoded information about the form.
|
| PDF417BarCode1 | Text |
This field contains a PDF417 barcode with encoded information about the form.
|
| PDF417BarCode1 | Text |
This is a barcode field that contains encoded information about the form. No input is required.
|
| PDF417BarCode1 | Text |
PDF417 barcode containing encoded information about the form.
|
| PDF417BarCode1 | Text |
This is a barcode field that contains encoded information about the form. No input is required from you.
|
| PDF417BarCode1 | Text |
This is a barcode field that contains encoded information about the form. No input is required.
|
| PDF417BarCode1 | Text |
This is a barcode field containing encoded information about the form.
|
| General Information | ||
| PDF417BarCode1 | Text |
This field contains a barcode that encodes specific information about the form and its version.
|
| PDF417BarCode1 | Text |
This is a barcode field that contains encoded information about the form.
|
| PDF417BarCode1 | Text |
This field contains a barcode that encodes specific information about the form, including its type and version.
|
| Immigration History | ||
| Part 3. Information About the Person for Whom This Petition Is Being Filed. Other Information. Complete Item Numbers 8. through 15. if this person is in the United States. If an item number is not applicable or the answer is "none," leave the space blank. Provide information below for the passport or other document used at the time of last arrival to the United States. 8. Enter Date of Last Arrival. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
Enter the date of last arrival to the United States for the person for whom this petition is being filed. Use the format MM/DD/YYYY.
|
| Part 3. Information About the Person for Whom This Petition Is Being Filed. Other Information. 9. Enter Form I - 94 Number or I - 95 Crewman's Landing Permit | Text |
Enter the Form I-94 Number or I-95 Crewman's Landing Permit number of the person for whom this petition is being filed. The number should be up to 11 digits long.
|
| Immigration Status Information | ||
| Part 3. Information About the Person for Whom This Petition Is Being Filed. Other Information. 15. Enter Date current status expired, or will expire, as shown on Form I - 94 or I - 95. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
Enter the date when the current status expired or will expire, as shown on Form I-94 or I-95. Use the format MM/DD/YYYY.
|
| Part 3. Information About the Person for Whom This Petition Is Being Filed. Other Information. 14. Enter Current Nonimmigration Status | Text |
Enter the current nonimmigrant status of the person for whom this petition is being filed.
|
| Information About the Beneficiary | ||
| Part 3. Information About the Person for Whom This Petition Is Being Filed. 1. Your Full Name. Enter Middle Name | Text |
Enter the middle name of the person for whom this petition is being filed.
|
| Part 3. Information About the Person for Whom This Petition Is Being Filed. 1. Your Full Name. Enter Given Name (First Name) | Text |
Enter the given name (first name) of the person for whom this petition is being filed.
|
| Part 3. Information About the Person for Whom This Petition Is Being Filed. NOTE: On this petition, the "beneficiary" or "self-petitioner" means the person for whom this petition is being filed. If you provided an alternate and/or safe mailing address above, you must also complete Part 3. 1. Your Full Name. Enter Family Name (Last Name) | Text |
Enter the family name (last name) of the person for whom this petition is being filed.
|
| Internal Processing | ||
| PDF417BarCode1 | Text |
This is a barcode field used for internal processing and tracking of the form. No input is required from the user.
|
| Internal Use | ||
| PDF417BarCode1 | Text |
This is a barcode field for internal use by USCIS.
|
| Interpreter Certification | ||
| Part 13. Interpreter's Contact Information, Certification, and Signature. Interpreter's Certification. I certify, under penalty of perjury, that I am fluent in English and (Enter Language), which is the same language specified in Part 11., Item B. in Item Number 1., or in Part 12., Item B. in Item Number 1., and I have read to this petitioner or the authorized signatory in the identified language every question and instruction on this petition and his or her answer to every question. The petitioner or authorized signatory informed me that he or she understands every instruction, question, and answer on the petition, including the Petitioner's Declaration and Certification, or Petitioner's or Authorized Signatory's Declaration and Certification, and has verified the accuracy of every answer | Text |
Enter the language in which the interpreter is fluent and has used to read and explain the form to the petitioner or authorized signatory.
|
| Interpreter Contact Information | ||
| Part 13. Interpreter's Contact Information, Certification, and Signature. Interpreter's Contact Information. 5. Enter Interpreter's Mobile Telephone Number, if any | Text |
Enter the mobile telephone number of the interpreter, if available.
|
| Part 13. Interpreter's Contact Information, Certification, and Signature. Interpreter's Contact Information. 4. Enter Interpreter's Daytime Telephone Number | Text |
Enter the daytime telephone number of the interpreter.
|
| Interpreter Information | ||
| Part 11. Petitioner's Statement, Contact Information, Declaration, and Signature (Individual). Petitioner's Statement. 1. Petitioner's Statement Regarding the Interpreter. B. Enter Language | Text |
Enter the language used by the interpreter if one was used to help you complete this form.
|
| Interpreter Mailing Address | ||
| Part 13. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. Enter Street Number and Name | Text |
Enter the street number and name of the interpreter's mailing address.
|
| Part 13. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. Select Suite | CheckBox |
Select this checkbox if the interpreter's mailing address includes a suite number.
|
| Interpreter Signature | ||
| Part 13. Interpreter's Contact Information, Certification, and Signature. Interpreter's Signature. 7. Enter Date of Signature. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
Enter the date when the interpreter signed the form. Use the format MM/DD/YYYY.
|
| Part 13. Interpreter's Contact Information, Certification, and Signature. Interpreter's Signature. 7. Interpreter's Signature. This form can not be signed electronically. The name of the interpreter can not be typewritten into this space. This is a protected field. Print and sign in ink | Text |
The interpreter must sign this form in ink. Electronic signatures or typewritten names are not allowed.
|
| Interpreter's Contact Information | ||
| Part 13. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. Enter Country | Text |
Enter the country of the interpreter's mailing address.
|
| Part 13. Interpreter's Contact Information, Certification, and Signature. Interpreter's Contact Information. 6. Enter Interpreter's Email Address, if any | Text |
Enter the interpreter's email address, if available.
|
| Part 13. Interpreter's Contact Information, Certification, and Signature. Provide the following information about the interpreter. Interpreter's Full Name. 1. Enter Interpreter's Family Name (Last Name) | Text |
Enter the interpreter's family name (last name).
|
| Part 13. Interpreter's Contact Information, Certification, and Signature. Interpreter's Full Name. 1. Enter Interpreter's Given Name (First Name) | Text |
Enter the interpreter's given name (first name).
|
| Part 13. Interpreter's Contact Information, Certification, and Signature. 2. Enter Interpreter's Business or Organization Name, if any | Text |
Enter the interpreter's business or organization name, if any. Maximum length is 34 characters.
|
| Interpreter's Mailing Address | ||
| Part 13. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. Select Apartment | CheckBox |
Check this box if the interpreter's mailing address includes an apartment.
|
| Part 13. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. Select Floor | CheckBox |
Check this box if the interpreter's mailing address includes a floor.
|
| Part 13. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. Enter Apartment, Suite or Floor Number | Text |
Enter the apartment, suite, or floor number of the interpreter's mailing address. Maximum length is 6 characters.
|
| Part 13. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. Enter City or Town | Text |
Enter the city or town of the interpreter's mailing address. Maximum length is 20 characters.
|
| Part 13. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. Select State from List of States | ComboBox |
Select the state from the provided list for the interpreter's mailing address.
OR
DE
UT
AZ
GA
NV
SD
MS
TX
IA
CA
WA
WY
FL
AE
WV
PA
AR
MD
NH
NC
AS
AA
ID
MA
DC
KS
MO
NY
LA
WI
AL
GU
MH
MN
AP
CT
NM
NJ
PR
IN
VA
FM
RI
OH
OK
HI
MT
VT
SC
MP
TN
CO
ME
ND
VI
KY
MI
AK
IL
PW
NE
|
| Part 13. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. Enter Zip Code | Text |
Enter the ZIP code of the interpreter's mailing address. Maximum length is 5 characters.
|
| Part 13. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. Enter Postal Code | Text |
Enter the postal code of the interpreter's mailing address. Maximum length is 9 characters.
|
| Part 13. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. Enter Province | Text |
Enter the province of the interpreter's mailing address. Maximum length is 20 characters.
|
| Mailing Address | ||
| Part 1. Information About Person or Organization Filing This Petition. 6. Mailing Address. Enter Street Number and Name | Text |
Enter the street number and name of the mailing address for the person or organization filing this petition.
|
| Part 1. Information About Person or Organization Filing This Petition. 6. Mailing Address. Select Suite | CheckBox |
Select this checkbox if the mailing address includes a suite number.
|
| Part 1. Information About Person or Organization Filing This Petition. 6. Mailing Address. Select Apartment | CheckBox |
Select this checkbox if the mailing address includes an apartment number.
|
| Part 1. Information About Person or Organization Filing This Petition. 6. Mailing Address. Select Floor | CheckBox |
Select this checkbox if the mailing address includes a floor number.
|
| Part 1. Information About Person or Organization Filing This Petition. 6. Mailing Address. Enter Apartment, Suite or Floor Number | Text |
Enter the apartment, suite, or floor number of the mailing address.
|
| Part 1. Information About Person or Organization Filing This Petition. 6. Mailing Address. Enter City or Town | Text |
Enter the city or town of the mailing address for the person or organization filing this petition.
|
| Part 1. Information About Person or Organization Filing This Petition. 6. Mailing Address. Select State from List of States | ComboBox |
Select the state from the provided list where the person or organization filing this petition receives mail.
OR
DE
UT
AZ
GA
NV
SD
MS
TX
IA
CA
WA
WY
FL
AE
WV
PA
AR
MD
NH
NC
AS
AA
ID
MA
DC
KS
MO
NY
LA
WI
AL
GU
MH
MN
AP
CT
NM
NJ
PR
IN
VA
FM
RI
OH
OK
HI
MT
VT
SC
MP
TN
CO
ME
ND
VI
KY
MI
AK
IL
PW
NE
|
| Part 1. Information About Person or Organization Filing This Petition. 6. Mailing Address. Enter Zip Code | Text |
Enter the 5-digit ZIP code for the mailing address of the person or organization filing this petition.
|
| Part 1. Information About Person or Organization Filing This Petition. 6. Mailing Address. Enter Postal Code | Text |
Enter the postal code for the mailing address of the person or organization filing this petition. This can be up to 9 characters long.
|
| Part 1. Information About Person or Organization Filing This Petition. 6. Mailing Address. Enter Province | Text |
Enter the province for the mailing address of the person or organization filing this petition. This can be up to 20 characters long.
|
| Part 1. Information About Person or Organization Filing This Petition. 6. Mailing Address. Enter Country | Text |
Enter the country for the mailing address of the person or organization filing this petition.
|
| Part 1. Information About Person or Organization Filing This Petition. 6. Mailing Address. Enter In Care Of Name, if any | Text |
Enter the name of the person in care of whom the mail should be sent, if applicable. This can be up to 34 characters long.
|
| Part 1. Information About Person or Organization Filing This Petition. 6. Mailing Address. Enter Organization Name, if applicable | Text |
Enter the name of the organization, if applicable, for the mailing address of the person or organization filing this petition. This can be up to 34 characters long.
|
| Part 1. Information About Person or Organization Filing This Petition. 7. Alternate and / or Safe Mailing Address. Enter Apartment, Suite or Floor Number | Text |
Enter the apartment, suite, or floor number for the alternate and/or safe mailing address of the person or organization filing this petition.
|
| Part 1. Information About Person or Organization Filing This Petition. 7. Alternate and / or Safe Mailing Address. Enter City or Town | Text |
Enter the city or town for the alternate and/or safe mailing address of the person or organization filing this petition.
|
| Part 1. Information About Person or Organization Filing This Petition. 7. Alternate and / or Safe Mailing Address. Select State from List of States | ComboBox |
Select the state from the list of states for the alternate and/or safe mailing address of the person or organization filing this petition.
OR
DE
UT
AZ
GA
NV
SD
MS
TX
IA
CA
WA
WY
FL
AE
WV
PA
AR
MD
NH
NC
AS
AA
ID
MA
DC
KS
MO
NY
LA
WI
AL
GU
MH
MN
AP
CT
NM
NJ
PR
IN
VA
FM
RI
OH
OK
HI
MT
VT
SC
MP
TN
CO
ME
ND
VI
KY
MI
AK
IL
PW
NE
|
| Part 1. Information About Person or Organization Filing This Petition. 7. Alternate and / or Safe Mailing Address. Enter Zip Code | Text |
Enter the ZIP code for the alternate and/or safe mailing address of the person or organization filing this petition.
|
| Part 1. Information About Person or Organization Filing This Petition. 7. Alternate and / or Safe Mailing Address. Enter Postal Code | Text |
Enter the postal code for the alternate and/or safe mailing address of the person or organization filing this petition.
|
| Part 1. Information About Person or Organization Filing This Petition. 7. Alternate and / or Safe Mailing Address. Enter Province | Text |
Enter the province for the alternate and/or safe mailing address of the person or organization filing this petition.
|
| Part 1. Information About Person or Organization Filing This Petition. 7. Alternate and / or Safe Mailing Address. Enter Country | Text |
Enter the country for the alternate and/or safe mailing address of the person or organization filing this petition.
|
| Part 3. Information About the Person for Whom This Petition Is Being Filed. 2. Mailing Address. Enter Street Number and Name | Text |
Enter the street number and name for the mailing address of the person for whom this petition is being filed.
|
| Part 3. Information About the Person for Whom This Petition Is Being Filed. 2. Mailing Address. Select Suite | CheckBox |
Select this checkbox if the mailing address includes a suite.
|
| Part 3. Information About the Person for Whom This Petition Is Being Filed. 2. Mailing Address. Select Apartment | CheckBox |
Select this checkbox if the mailing address includes an apartment.
|
| Part 3. Information About the Person for Whom This Petition Is Being Filed. 2. Mailing Address. Select Floor | CheckBox |
Select this checkbox if the mailing address includes a floor.
|
| Part 3. Information About the Person for Whom This Petition Is Being Filed. 2. Mailing Address. Enter Apartment, Suite or Floor Number | Text |
Enter the apartment, suite, or floor number for the mailing address of the person for whom this petition is being filed.
|
| Part 3. Information About the Person for Whom This Petition Is Being Filed. 2. Mailing Address. Enter City or Town | Text |
Enter the city or town for the mailing address of the person for whom this petition is being filed.
|
| Part 3. Information About the Person for Whom This Petition Is Being Filed. 2. Mailing Address. Select State from List of States | ComboBox |
Select the state from the list of states for the mailing address of the person for whom this petition is being filed.
OR
DE
UT
AZ
GA
NV
SD
MS
TX
IA
CA
WA
WY
FL
AE
WV
PA
AR
MD
NH
NC
AS
AA
ID
MA
DC
KS
MO
NY
LA
WI
AL
GU
MH
MN
AP
CT
NM
NJ
PR
IN
VA
FM
RI
OH
OK
HI
MT
VT
SC
MP
TN
CO
ME
ND
VI
KY
MI
AK
IL
PW
NE
|
| Part 3. Information About the Person for Whom This Petition Is Being Filed. 2. Mailing Address. Enter Zip Code | Text |
Enter the zip code for the mailing address of the person for whom this petition is being filed.
|
| Part 3. Information About the Person for Whom This Petition Is Being Filed. 2. Mailing Address. Enter Postal Code | Text |
Enter the postal code for the mailing address of the person for whom this petition is being filed.
|
| Part 3. Information About the Person for Whom This Petition Is Being Filed. 2. Mailing Address. Enter Province | Text |
Enter the province of the mailing address for the person for whom this petition is being filed.
|
| Part 3. Information About the Person for Whom This Petition Is Being Filed. 2. Mailing Address. Enter Country | Text |
Enter the country of the mailing address for the person for whom this petition is being filed.
|
| Part 4. Processing Information. 2. B. Mailing Address. Select Suite | CheckBox |
Select this checkbox if the mailing address includes a suite.
|
| Part 4. Processing Information. 2. B. Mailing Address. Select Apartment | CheckBox |
Select this checkbox if the mailing address includes an apartment.
|
| Part 4. Processing Information. 2. B. Mailing Address. Select Floor | CheckBox |
Select this checkbox if the mailing address includes a floor.
|
| Part 4. Processing Information. 2. B. Mailing Address. Enter Apartment, Suite or Floor Number | Text |
Enter the apartment, suite, or floor number of the mailing address.
|
| Part 4. Processing Information. 2. B. Mailing Address. Enter Postal Code | Text |
Enter the postal code of the mailing address.
|
| Part 4. Processing Information. 2. B. Mailing Address. Enter City or Town | Text |
Enter the city or town of the mailing address.
|
| Part 4. Processing Information. 2. B. Mailing Address. Enter Country | Text |
Enter the country of the mailing address.
|
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Mailing Address. 17. Select State from List of States | ComboBox |
Select the state from the provided list where the mailing address is located.
OR
DE
UT
AZ
GA
NV
SD
MS
TX
IA
CA
WA
WY
FL
AE
WV
PA
AR
MD
NH
NC
AS
AA
ID
MA
DC
KS
MO
NY
LA
WI
AL
GU
MH
MN
AP
CT
NM
NJ
PR
IN
VA
FM
RI
OH
OK
HI
MT
VT
SC
MP
TN
CO
ME
ND
VI
KY
MI
AK
IL
PW
NE
|
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Mailing Address. 17. Enter Zip Code | Text |
Enter the 5-digit zip code for the mailing address.
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| Mailing Address Information | ||
| Part 3. Information About the Person for Whom This Petition Is Being Filed. 2. Mailing Address. Enter In Care Of Name (if any) | Text |
Enter the 'In Care Of' name for the mailing address of the person for whom this petition is being filed, if applicable.
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| Marital Status | ||
| Part 3. Information About the Person for Whom This Petition Is Being Filed. Other Information. 7. Marital Status. Select Single | CheckBox |
Select this checkbox if the person for whom this petition is being filed is single.
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| Part 3. Information About the Person for Whom This Petition Is Being Filed. Other Information. 7. Marital Status. Select Married | CheckBox |
Select this checkbox if the person for whom this petition is being filed is married.
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| Part 3. Information About the Person for Whom This Petition Is Being Filed. Other Information. 7. Marital Status. Select Divorced | CheckBox |
Select this checkbox if the person for whom this petition is being filed is divorced.
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| Part 3. Information About the Person for Whom This Petition Is Being Filed. Other Information. 7. Marital Status. Select Widowed | CheckBox |
Select this checkbox if the person for whom this petition is being filed is widowed.
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| Part 7. Complete Only If Filing as a Widow / Widower. 9. A. Did you remarry after the death of your spouse? Select No | CheckBox |
Select 'No' if you did not remarry after the death of your spouse.
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| Part 7. Complete Only If Filing as a Widow / Widower. 10. If you are filing as a widow(er), were you legally separated at the time of the U.S. citizen's death? Select Yes. NOTE: If you answered "Yes" to Item Number 10., provide an explanation in the space provided in Part 15. Additional Information | CheckBox |
Select 'Yes' if you were legally separated at the time of the U.S. citizen's death. Provide an explanation in Part 15 if you select 'Yes'.
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| Part 7. Complete Only If Filing as a Widow / Widower. 10. If you are filing as a widow(er), were you legally separated at the time of the U.S. citizen's death? Select No | CheckBox |
Select 'No' if you were not legally separated at the time of the U.S. citizen's death.
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| Part 7. Complete Only If Filing as a Widow / Widower. 9. A. Did you remarry after the death of your spouse? Select Yes | CheckBox |
Select 'Yes' if you remarried after the death of your spouse.
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| Marriage Details | ||
| Part 7. Complete Only If Filing as a Widow / Widower. 8. B. Where did you and your spouse get married | Text |
Enter the place where you and your spouse got married.
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| Part 7. Complete Only If Filing as a Widow / Widower. 9. B. If you answered "Yes" to Item A. in Item Number 9., provide the date that you remarried. Enter Date Remarried. Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Date |
If you remarried after the death of your spouse, provide the date of your remarriage in the format MM/DD/YYYY.
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| Part 7. Complete Only If Filing as a Widow / Widower. 8. A. When did you and your spouse get married? Enter Date of Marriage. Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Date |
Enter the date when you and your spouse got married in the format MM/DD/YYYY.
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| Marriage Information | ||
| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 8. A. When did you and your abuser get married? (If you are a self-petitioning child or self-petitioning parent, type or print "N/A."). Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Date |
Enter the date when you and your abuser got married. If you are a self-petitioning child or parent, enter 'N/A'. Use the format MM/DD/YYYY.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 8. B. Where did you and your abuser get married? (If you are a self-petitioning child or self-petitioning parent, type or print "N/A.") | Text |
Enter the place where you and your abuser got married. If you are a self-petitioning child or parent, enter 'N/A'.
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| Mother's Address | ||
| Part 6. Complete Only If Filing for an Amerasian. Information About the Mother of the Amerasian. 2. B. If you answered "Yes" to Item A. in Item Number 2., provide her address below. Enter In Care Of Name (if any) | Text |
If the mother is still alive, enter the 'In Care Of' name (if any) for her address.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Mother of the Amerasian. 2. B. If you answered "Yes" to Item A. in Item Number 2., provide her address below. Enter Street Number and Name | Text |
If the mother is still alive, enter the street number and name for her address.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Mother of the Amerasian. 2. B. If you answered "Yes" to Item A. in Item Number 2., provide her address below. Select Suite | CheckBox |
Select this checkbox if the address includes a suite.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Mother of the Amerasian. 2. B. If you answered "Yes" to Item A. in Item Number 2., provide her address below. Select Apartment | CheckBox |
Select this checkbox if the address includes an apartment.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Mother of the Amerasian. 2. B. If you answered "Yes" to Item A. in Item Number 2., provide her address below. Select Floor | CheckBox |
Select this checkbox if the address includes a floor.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Mother of the Amerasian. 2. B. If you answered "Yes" to Item A. in Item Number 2., provide her address below. Enter Apartment, Suite or Floor Number | Text |
If the mother is still alive, enter the apartment, suite, or floor number for her address.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Mother of the Amerasian. 2. B. If you answered "Yes" to Item A. in Item Number 2., provide her address below. Enter City or Town | Text |
Enter the city or town of the address of the mother of the Amerasian if you answered 'Yes' to Item A in Item Number 2.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Mother of the Amerasian. 2. B. If you answered "Yes" to Item A. in Item Number 2., provide her address below. Select State from List of States | ComboBox |
Select the state from the list of states for the address of the mother of the Amerasian if you answered 'Yes' to Item A in Item Number 2.
OR
DE
UT
AZ
GA
NV
SD
MS
TX
IA
CA
WA
WY
FL
AE
WV
PA
AR
MD
NH
NC
AS
AA
ID
MA
DC
KS
MO
NY
LA
WI
AL
GU
MH
MN
AP
CT
NM
NJ
PR
IN
VA
FM
RI
OH
OK
HI
MT
VT
SC
MP
TN
CO
ME
ND
VI
KY
MI
AK
IL
PW
NE
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Mother of the Amerasian. 2. B. If you answered "Yes" to Item A. in Item Number 2., provide her address below. Enter Zip Code | Text |
Enter the zip code of the address of the mother of the Amerasian if you answered 'Yes' to Item A in Item Number 2.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Mother of the Amerasian. 2. B. If you answered "Yes" to Item A. in Item Number 2., provide her address below. Enter Postal Code | Text |
Enter the postal code of the address of the mother of the Amerasian if you answered 'Yes' to Item A in Item Number 2.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Mother of the Amerasian. 2. B. If you answered "Yes" to Item A. in Item Number 2., provide her address below. Enter Province | Text |
Enter the province of the address of the mother of the Amerasian if you answered 'Yes' to Item A in Item Number 2.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Mother of the Amerasian. 2. B. If you answered "Yes" to Item A. in Item Number 2., provide her address below. Enter Country | Text |
Enter the country of the address of the mother of the Amerasian if you answered 'Yes' to Item A in Item Number 2.
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| Mother's Information | ||
| Part 6. Complete Only If Filing for an Amerasian. Information About the Mother of the Amerasian. 1. Mother's Full Name. Enter Given Name (First Name) | Text |
Enter the given name (first name) of the mother of the Amerasian.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Mother of the Amerasian. 1. Mother's Full Name. Enter Family Name (Last Name) | Text |
Enter the family name (last name) of the mother of the Amerasian.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Mother of the Amerasian. 2. A. Is the mother still alive? Select Unknown | CheckBox |
Select this checkbox if the status of the mother being alive is unknown.
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| Part 6. Complete Only If Filing for an Amerasian. Information About the Mother of the Amerasian. 2. A. Is the mother still alive? Select No | CheckBox |
Indicate whether the mother of the Amerasian is still alive by selecting 'No'.
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| Organizational Relationship | ||
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 5. Describe the relationship, if any, between the religious organization in the United States and the organization abroad of which the beneficiary is a member | Text |
Describe the relationship, if any, between the religious organization in the United States and the organization abroad of which the beneficiary is a member.
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| Passport Information | ||
| Part 3. Information About the Person for Whom This Petition Is Being Filed. Other Information. 10. Enter Passport Number | Text |
Enter the passport number of the person for whom this petition is being filed.
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| Part 3. Information About the Person for Whom This Petition Is Being Filed. Other Information. 13. Enter Expiration Date for Passport or Travel Document. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
Enter the expiration date of the passport or travel document. Use the format MM/DD/YYYY.
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| Personal Information | ||
| Part 1. Information About Person or Organization Filing This Petition. 3. Enter U.S. Social Security Number, if any | Text |
Enter the U.S. Social Security Number (SSN) of the person or organization filing this petition, if available. This can be up to 9 characters long.
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| Part 1. Information About Person or Organization Filing This Petition. 4. Enter Alien Registration Number (A. Number), if any | Text |
Enter the Alien Registration Number (A-Number) of the person or organization filing this petition, if available. This can be up to 9 characters long.
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| Part 3. Information About the Person for Whom This Petition Is Being Filed. Other Information. 3. Enter Date of Birth. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
Enter the date of birth of the person for whom this petition is being filed. Use the format MM/DD/YYYY.
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| Part 3. Information About the Person for Whom This Petition Is Being Filed. Other Information. 5. Enter U.S. Social Security Number, if any | Text |
Enter the U.S. Social Security Number of the person for whom this petition is being filed, if they have one. The number should be exactly 9 digits long.
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| Part 3. Information About the Person for Whom This Petition Is Being Filed. Other Information. 4. Enter Country of Birth | Text |
Enter the country of birth of the person for whom this petition is being filed.
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| Part 3. Information About the Person for Whom This Petition Is Being Filed. Other Information. 6. Enter Alien Registration Number (A. Number), if any | Text |
Enter the Alien Registration Number (A-Number) of the person for whom this petition is being filed, if they have one. The number should be exactly 9 digits long.
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| Part 4. Processing Information. 2. A. Your Full Name. Enter Middle Name | Text |
Enter the middle name of the petitioner.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 2. Enter Date of Birth. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
Enter your date of birth in the format MM/DD/YYYY. This field is required if you are filing as a VAWA self-petitioning spouse, child, or parent of a U.S. citizen or lawful permanent resident.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 3. Enter Country of Birth | Text |
Enter the country where you were born. This field is required if you are filing as a VAWA self-petitioning spouse, child, or parent of a U.S. citizen or lawful permanent resident.
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| Part 15. Additional Information. If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Type or print your name and A. Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet. 1. Enter Family Name (Last Name) | Text |
Enter your family name (last name) as it appears on the form. If you need extra space to provide additional information, use this section.
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| Part 15. Additional Information. 1. Enter Given Name (First Name) | Text |
Enter your given name (first name) as it appears on the form. If you need extra space to provide additional information, use this section.
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| Petitioner Information | ||
| Part 1. Information About Person or Organization Filing This Petition. 2. Enter U S C I S Online Account Number, if any | Text |
Enter your USCIS Online Account Number if you have one. This number is used to access your online account with USCIS.
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| Part 1. Information About Person or Organization Filing This Petition. 1. Your Full Name. Enter Middle Name | Text |
Enter the middle name of the person or organization filing this petition.
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| Part 1. Information About Person or Organization Filing This Petition. 1. Your Full Name. Enter Given Name (First Name) | Text |
Enter the given name (first name) of the person or organization filing this petition.
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| Part 1. Information About Person or Organization Filing This Petition. NOTE: You must complete Part 1. as the petitioner if you are filing this petition on behalf of another person. If you are a Violence Against Women Act (V. A. W. A.) self-petitioner or special immigrant juvenile, skip to Part 1., Item Number 7. 1. Your Full Name. Enter Family Name (Last Name) | Text |
Enter the family name (last name) of the person or organization filing this petition.
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| Part 1. Information About Person or Organization Filing This Petition. 5. Enter Individual Internal Revenue Service (I R S) Tax Number, if any | Text |
Enter the Individual Internal Revenue Service (IRS) Tax Number, if any. This is used to identify the petitioner for tax purposes.
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| Petitioner's Contact Information | ||
| Part 11. Petitioner's Statement, Contact Information, Declaration, and Signature (Individual). Petitioner's Contact Information. 4. Enter Petitioner's Mobile Telephone Number, if any | Text |
Enter the petitioner's mobile telephone number, if available. This should be a 10-digit number.
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| Part 11. Petitioner's Statement, Contact Information, Declaration, and Signature (Individual). Petitioner's Contact Information. 5. Enter Petitioner's Email Address, if any | Text |
Enter the petitioner's email address, if available. This will be used for communication purposes.
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| Part 11. Petitioner's Statement, Contact Information, Declaration, and Signature (Individual). Petitioner's Contact Information. 3. Enter Petitioner's Daytime Telephone Number | Text |
Enter the petitioner's daytime telephone number. This should be a 10-digit number.
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| Petitioner's or Authorized Signatory's Signature | ||
| Part 12. Statement, Contact Information, Declaration, and Signature of the Petitioner or Authorized Signatory. Petitioner's or Authorized Signatory's Signature. 8. Enter Date of Signature. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
Enter the date of signature in the format MM/DD/YYYY.
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| Petitioner's or Authorized Signatory's Statement | ||
| Part 12. Statement, Contact Information, Declaration, and Signature of the Petitioner or Authorized Signatory. IMPORTANT: Complete this section ONLY if you are filing Form I-3 60 to petition for another person or as an authorized signatory of an organization. If you are an individual filing this petition for yourself, complete Part 11. Petitioner's Statement, Contact Information, Declaration, and Signature (Individual). NOTE: Read the Penalties section of the Form I-3 60 Instructions before completing this part. Petitioner's or Authorized Signatory's Statement. NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2. 1. Petitioner's Statement Regarding the Interpreter. A. Select I can read and understand English, and I have read and understand every question and instruction on this petition and my answer to every question | CheckBox |
Select this checkbox if you can read and understand English and have read and understood every question and instruction on this petition.
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| Part 12. Statement, Contact Information, Declaration, and Signature of the Petitioner or Authorized Signatory. Petitioner's or Authorized Signatory's Statement. 1. Petitioner's Statement Regarding the Interpreter. B. Enter Language | Text |
Enter the language in which you are fluent if you used an interpreter to understand the petition.
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| Part 12. Statement, Contact Information, Declaration, and Signature of the Petitioner or Authorized Signatory. Petitioner's or Authorized Signatory's Statement. NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2. 1. Petitioner's Statement Regarding the Interpreter. B. Select The interpreter named in Part 13. read to me every question and instruction on this petition and my answer to every question in the language which I am fluent. I understand all of this information as interpreted | CheckBox |
Select this checkbox if an interpreter read to you every question and instruction on this petition in a language in which you are fluent, and you understand all the information as interpreted.
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| Petitioner's Statement | ||
| Part 11. Petitioner's Statement, Contact Information, Declaration, and Signature (Individual). IMPORTANT: Complete this section ONLY if you are an individual filing this petition for yourself. If you are filing Form I-3 60 to petition for another person or as an authorized signatory of an organization, complete Part 12. Statement, Contact Information, Declaration, and Signature of the Petitioner or Authorized Signatory. NOTE: Read the Penalties section of the Form I-3 60 Instructions before completing this part. Petitioner's Statement. NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2. 1. Petitioner's Statement Regarding the Interpreter. A. Select I can read and understand English, and I have read and understand every question and instruction on this petition and my answer to every question | CheckBox |
Select this checkbox if you can read and understand English, and you have read and understand every question and instruction on this petition and your answer to every question.
|
| Part 11. Petitioner's Statement, Contact Information, Declaration, and Signature (Individual). Petitioner's Statement. NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2. 1. Petitioner's Statement Regarding the Interpreter. B. Select The interpreter named in Part 13. read to me every question and instruction on this petition, as well as my answer to every question in a language in which I am fluent. I understand all of this information as interpreted | CheckBox |
Select this checkbox if the interpreter named in Part 13 read to you every question and instruction on this petition, as well as your answer to every question in a language in which you are fluent. You understand all of this information as interpreted.
|
| Preparer Information | ||
| Part 11. Petitioner's Statement, Contact Information, Declaration, and Signature (Individual). Petitioner's Statement. NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2. 2. Petitioner's Statement Regarding the Preparer. Select At my request, the preparer named in Part 14 prepared this petition for me based only upon information I provided or authorized | CheckBox |
Select this checkbox if the preparer named in Part 14 prepared this petition for you based only on the information you provided or authorized.
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| Part 11. Petitioner's Statement, Contact Information, Declaration, and Signature (Individual). Petitioner's Statement. NOTE: Select the box for either Item. A or B. in Item Number 1. If applicable, select the box for Item Number 2. 2. Petitioner's Statement Regarding the Preparer. Enter Preparer Name | Text |
Enter the name of the preparer who helped you complete this petition, if applicable.
|
| Part 14. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner. 2. Enter Preparer's Business or Organization Name, if any | Text |
Enter the business or organization name of the person preparing this petition, if applicable.
|
| Part 14. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner. Provide the following information about the preparer. Preparer's Full Name. 1. Enter Preparer's Family Name (Last Name) | Text |
Enter the family name (last name) of the person preparing this petition.
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| Part 14. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner. Preparer's Signature. 8. Preparer's Signature. This form can not be signed electronically. The name of the preparer can not be typewritten into this space. This is a protected field. Print and sign in ink | Text |
The preparer must sign this form in ink. Electronic signatures are not accepted.
|
| Preparer's Contact Information | ||
| Part 14. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner. Preparer's Contact Information. 5. Enter Preparer's Mobile Number | Text |
Enter the preparer's mobile number. Maximum length is 10 digits.
|
| Part 14. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner. Preparer's Contact Information. 4. Enter Preparer's Daytime Telephone Number | Text |
Enter the preparer's daytime telephone number. Maximum length is 10 digits.
|
| Part 14. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner. Preparer's Contact Information. 6. Enter Preparer's Email Address, if any | Text |
Enter the preparer's email address, if available.
|
| Preparer's Full Name | ||
| Part 14. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner. Preparer's Full Name. 1. Enter Preparer's Given Name (First Name) | Text |
Enter the given name (first name) of the person who prepared this petition, if different from the petitioner.
|
| Preparer's Mailing Address | ||
| Part 14. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner. Preparer's Mailing Address. 3. Enter Street Number and Name | Text |
Enter the street number and name of the preparer's mailing address. Maximum length is 34 characters.
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| Part 14. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner. Preparer's Mailing Address. 3. Select Suite | CheckBox |
Check this box if the preparer's mailing address includes a suite.
|
| Part 14. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner. Preparer's Mailing Address. 3. Select Apartment | CheckBox |
Check this box if the preparer's mailing address includes an apartment.
|
| Part 14. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner. Preparer's Mailing Address. 3. Select Floor | CheckBox |
Check this box if the preparer's mailing address includes a floor.
|
| Part 14. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner. Preparer's Mailing Address. 3. Enter Apartment, Suite or Floor Number | Text |
Enter the apartment, suite, or floor number of the preparer's mailing address. Maximum length is 6 characters.
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| Part 14. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner. Preparer's Mailing Address. 3. Enter City or Town | Text |
Enter the city or town of the preparer's mailing address. Maximum length is 20 characters.
|
| Part 14. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner. Preparer's Mailing Address. 3. Select State from List of States | ComboBox |
Select the state from the list of states for the preparer's mailing address.
OR
DE
UT
AZ
GA
NV
SD
MS
TX
IA
CA
WA
WY
FL
AE
WV
PA
AR
MD
NH
NC
AS
AA
ID
MA
DC
KS
MO
NY
LA
WI
AL
GU
MH
MN
AP
CT
NM
NJ
PR
IN
VA
FM
RI
OH
OK
HI
MT
VT
SC
MP
TN
CO
ME
ND
VI
KY
MI
AK
IL
PW
NE
|
| Part 14. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner. Preparer's Mailing Address. 3. Enter Zip Code | Text |
Enter the ZIP code of the preparer's mailing address. Maximum length is 5 characters.
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| Part 14. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner. Preparer's Mailing Address. 3. Enter Postal Code | Text |
Enter the postal code of the preparer's mailing address. Maximum length is 9 characters.
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| Part 14. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner. Preparer's Mailing Address. 3. Enter Province | Text |
Enter the province of the person who prepared this petition, if different from the petitioner.
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| Part 14. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner. Preparer's Mailing Address. 3. Enter Country | Text |
Enter the country of the person who prepared this petition, if different from the petitioner.
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| Preparer's Signature | ||
| Part 14. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner. Preparer's Signature. 8. Enter Date of Signature. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
Enter the date of the preparer's signature in the format MM/DD/YYYY.
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| Preparer's Statement | ||
| Part 14. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner. Preparer's Statement. 7. A. Select I am not an attorney or accredited representative but have prepared this petition on behalf of the petitioner and with the petitioner's consent | CheckBox |
Select this checkbox if you are not an attorney or accredited representative but have prepared this petition on behalf of the petitioner and with the petitioner's consent.
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| Part 14. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner. Preparer's Statement. 7. B. Select I am an attorney or accredited representative | CheckBox |
Select this checkbox if you are an attorney or accredited representative.
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| Part 14. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner. Preparer's Statement. 7. B. Select I am an attorney or accredited representative and my representation of the petitioner in this case does not extend beyond the preparation of this petition | CheckBox |
Select this checkbox if you are an attorney or accredited representative and your representation of the petitioner in this case does not extend beyond the preparation of this petition.
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| Part 14. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner. Preparer's Statement. 7. B. Select I am an attorney or accredited representative and my representation of the petitioner in this case extends beyond the preparation of this petition. NOTE: If you are an attorney or accredited representative whose representation extends beyond preparation of this petition, you may be obliged to submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, or G-28 I, Notice of Entry of Appearance as Attorney In Matters Outside the Geographical Confines of the United States, with this petition | CheckBox |
Select this checkbox if you are an attorney or accredited representative and your representation of the petitioner in this case extends beyond the preparation of this petition. Note: You may need to submit a completed Form G-28 or G-28I with this petition.
|
| Processing Information | ||
| Part 4. Processing Information. 4. B. If you answered "Yes" to Item A. in Item Number 4., how many | Number |
If you answered 'Yes' to the question about filing other petitions or applications, specify how many you are filing.
|
| Part 4. Processing Information. 4. A. Are you filing any other petitions or applications with this one? Select Yes | CheckBox |
Indicate whether you are filing any other petitions or applications along with this one by selecting 'Yes'.
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| Part 4. Processing Information. If you answer "Yes" to Item Numbers 5. through 6., provide an explanation in the space provided in Part 15. Additional Information. 5. Is the beneficiary in removal proceedings? Select Yes | CheckBox |
Indicate whether the beneficiary is currently in removal proceedings by selecting 'Yes'. If 'Yes', provide an explanation in Part 15.
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| Part 4. Processing Information. 4. A. Are you filing any other petitions or applications with this one? Select No | CheckBox |
Indicate whether you are filing any other petitions or applications along with this one by selecting 'No'.
|
| Part 4. Processing Information. 3. Gender of the beneficiary. Select Male | CheckBox |
Select 'Male' to indicate the gender of the beneficiary.
|
| Part 4. Processing Information. 3. Gender of the beneficiary. Select Female | CheckBox |
Select 'Female' to indicate the gender of the beneficiary.
|
| Part 4. Processing Information. 6. Has the beneficiary ever worked in the U.S. without permission? (If you are applying for a special immigrant juvenile status, you are not required to answer this item number.) Select Yes | CheckBox |
Indicate whether the beneficiary has ever worked in the U.S. without permission by selecting 'Yes'. Note: If applying for special immigrant juvenile status, you are not required to answer this question.
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| Part 4. Processing Information. 7. Is an application for adjustment of status attached to this petition? Select Yes | CheckBox |
Indicate whether an application for adjustment of status is attached to this petition by selecting 'Yes'.
|
| Part 4. Processing Information. 5. Is the beneficiary in removal proceedings? Select No | CheckBox |
Indicate whether the beneficiary is currently in removal proceedings by selecting 'No'.
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| Part 4. Processing Information. 6. Has the beneficiary ever worked in the U.S. without permission? (If you are applying for a special immigrant juvenile status, you are not required to answer this item number.) Select No | CheckBox |
Indicate whether the beneficiary has ever worked in the U.S. without permission by selecting 'No'. Note: If applying for special immigrant juvenile status, you are not required to answer this question.
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| Part 4. Processing Information. 7. Is an application for adjustment of status attached to this petition? Select No | CheckBox |
Indicate whether an application for adjustment of status is attached to this petition by selecting 'No'.
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| Part 4. Processing Information. 2. A. Your Full Name. Enter Given Name (First Name) | Text |
Enter your given name (first name) as part of the processing information.
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| Part 4. Processing Information. 2. If a U.S. address was provided in Part 3., type or print the person's foreign address below. If he or she does not maintain a foreign address, list the city or town and country of last foreign residence. If his or her native alphabet does not use Roman letters, type or print his or her name and foreign address in the native alphabet. A. Your Full Name. Enter Family Name (Last Name) | Text |
Enter your family name (last name) if a U.S. address was provided in Part 3. If you do not maintain a foreign address, list the city or town and country of your last foreign residence. If your native alphabet does not use Roman letters, type or print your name and foreign address in the native alphabet.
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| Part 4. Processing Information. 2. B. Mailing Address. Enter Province | Text |
Enter the province of the mailing address for processing information.
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| Prospective Employer Attestation | ||
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Prospective Employer Attestation (must be completed by the prospective employer even if the beneficiary is filing on his or her own behalf). 14. Enter Date of Signature. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
Enter the date of signature by the prospective employer. Use the format MM/DD/YYYY.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Prospective Employer Attestation (must be completed by the prospective employer even if the beneficiary is filing on his or her own behalf). I certify or attest under penalty of perjury under the laws of the United States of America that the contents of this attestation, and the evidence submitted, are true and correct. 14. Signature of an Authorized Official of the Prospective Employer. This form can not be signed electronically. The name of the official can not be typewritten into this space. This is a protected field. Print and sign in ink | Text |
Signature of an authorized official of the prospective employer. This form cannot be signed electronically. The name of the official cannot be typewritten into this space. Print and sign in ink.
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| Religious Denomination Certification | ||
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Religious Denomination Certification (to be completed only if the prospective employer is affiliated with a religious denomination). I certify under penalty of perjury, that the prospective employer is affiliated with this Religious Denomination, and that the attesting religious organization within the religious denomination is tax-exempt as described in section 501(c)(3) of the Internal Revenue Code of 1986, or equivalent sections of prior enactments of the Internal Revenue Code. The contents of this certification are true and correct to the best of my knowledge. Enter Name of Religious Denomination | Text |
Enter the name of the religious denomination that the prospective employer is affiliated with. This certification confirms the affiliation and tax-exempt status under section 501(c)(3) of the Internal Revenue Code.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Religious Denomination Certification (to be completed only if the prospective employer is affiliated with a religious denomination). 21. Enter Date of Signature. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
Enter the date of signature in the format MM/DD/YYYY.
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| Religious Organization Information | ||
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Information About the Attesting Religious Organization Within the Religious Denomination. 25. Select State from List of States | ComboBox |
Select the state from the list of states where the attesting religious organization is located.
OR
DE
UT
AZ
GA
NV
SD
MS
TX
IA
CA
WA
WY
FL
AE
WV
PA
AR
MD
NH
NC
AS
AA
ID
MA
DC
KS
MO
NY
LA
WI
AL
GU
MH
MN
AP
CT
NM
NJ
PR
IN
VA
FM
RI
OH
OK
HI
MT
VT
SC
MP
TN
CO
ME
ND
VI
KY
MI
AK
IL
PW
NE
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Information About the Attesting Religious Organization Within the Religious Denomination. 25. Enter Zip Code | Text |
Enter the ZIP code of the attesting religious organization.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Information About the Attesting Religious Organization Within the Religious Denomination. 27. Enter Fax Number, if any | Text |
Enter the fax number of the attesting religious organization, if available.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Information About the Attesting Religious Organization Within the Religious Denomination. 26. Enter Daytime Telephone Number | Text |
Enter the daytime telephone number of the attesting religious organization.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Information About the Attesting Religious Organization Within the Religious Denomination. 28. Enter Email Address, if any | Text |
Enter the email address of the attesting religious organization, if available.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Information About the Attesting Religious Organization Within the Religious Denomination. 29. Enter I R S Tax Number of the Attesting Religious Organization | Text |
Enter the IRS tax number of the attesting religious organization.
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| Religious Worker Petition | ||
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Religious Denomination Certification (to be completed only if the prospective employer is affiliated with a religious denomination). 21. Signature of the Authorized Representative of the Religious Denomination. This form can not be signed electronically. The name of the representative can not be typewritten into this space. This is a protected field. Print and sign in ink | Text |
Signature of the Authorized Representative of the Religious Denomination. This form cannot be signed electronically. The name of the representative cannot be typewritten into this space. Print and sign in ink.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Printed Name and Title of the Signatory of the Religious Denomination. 23. Enter Title of the Signatory | Text |
Enter the title of the signatory of the religious denomination.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Printed Name and Title of the Signatory of the Religious Denomination. 22. Enter Middle Name | Text |
Enter the middle name of the signatory of the religious denomination.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Printed Name and Title of the Signatory of the Religious Denomination. 22. Enter Given Name (First Name) | Text |
Enter the given name (first name) of the signatory of the religious denomination.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Printed Name and Title of the Signatory of the Religious Denomination. 22. Enter Family Name (Last Name) | Text |
Enter the family name (last name) of the signatory of the religious denomination.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Printed Name and Title of Signatory for Prospective Employer. 15. Enter Middle Name | Text |
Enter the middle name of the signatory for the prospective employer.
|
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Printed Name and Title of Signatory for Prospective Employer. 15. Enter Given Name (First Name) | Text |
Enter the given name (first name) of the signatory for the prospective employer.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Printed Name and Title of Signatory for Prospective Employer. 15. Enter Family Name (Last Name) | Text |
Enter the family name (last name) of the signatory for the prospective employer.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Religious Denomination Certification (to be completed only if the prospective employer is affiliated with a religious denomination). I certify under penalty of perjury, that the prospective employer. Enter Name of Prospective Employer | Text |
Enter the name of the prospective employer. This certification is to be completed only if the prospective employer is affiliated with a religious denomination.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Information About the Attesting Religious Organization Within the Religious Denomination. 24. Enter Name of Attesting Religious Organization Within the Religious Denomination | Text |
Enter the name of the attesting religious organization within the religious denomination for a Special Immigrant Religious Worker Petition.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Information About the Attesting Religious Organization Within the Religious Denomination. 25. Enter Street Number and Name | Text |
Enter the street number and name of the attesting religious organization within the religious denomination for a Special Immigrant Religious Worker Petition.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Information About the Attesting Religious Organization Within the Religious Denomination. 25. Select Suite | CheckBox |
Select this checkbox if the address of the attesting religious organization includes a suite number.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Information About the Attesting Religious Organization Within the Religious Denomination. 25. Select Apartment | CheckBox |
Select this checkbox if the address of the attesting religious organization includes an apartment number.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Information About the Attesting Religious Organization Within the Religious Denomination. 25. Select Floor | CheckBox |
Select this checkbox if the address of the attesting religious organization includes a floor number.
|
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Information About the Attesting Religious Organization Within the Religious Denomination. 25. Enter Apartment, Suite or Floor Number | Text |
Enter the apartment, suite, or floor number of the attesting religious organization within the religious denomination for a Special Immigrant Religious Worker Petition.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Information About the Attesting Religious Organization Within the Religious Denomination. 25. Enter City or Town | Text |
Enter the city or town of the attesting religious organization within the religious denomination for a Special Immigrant Religious Worker Petition.
|
| Signature | ||
| Part 12. Statement, Contact Information, Declaration, and Signature of the Petitioner or Authorized Signatory. Petitioner's or Authorized Signatory's Signature. 8. Petitioner's or Authorized Signatory's Signature. This form can not be signed electronically. The name of the petitioner or authorized signatory can not be typewritten into this space. This is a protected field. Print and sign in ink | Text |
This field requires the handwritten signature of the petitioner or authorized signatory. The name cannot be typewritten and must be signed in ink.
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| Signature Information | ||
| Part 11. Petitioner's Statement, Contact Information, Declaration, and Signature (Individual). Petitioner's Signature. 6. Enter Date of Signature. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
Enter the date when you signed this petition. Use the format MM/DD/YYYY.
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| Part 11. Petitioner's Statement, Contact Information, Declaration, and Signature (Individual). Petitioner's Signature. 6. Petitioner's Signature. This form can not be signed electronically. The name of the petitioner can not be typewritten into this space. This is a protected field. Print and sign in ink | Text |
Sign this petition in ink. The name of the petitioner cannot be typewritten into this space.
|
| Special Immigrant Juvenile Information | ||
| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information about the Juvenile. 1. List any other names used. B. Enter Middle Name | Text |
Enter the middle name of the juvenile if they have used any other names. This field is only applicable if you are filing for a Special Immigrant Juvenile.
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| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information about the Juvenile. 1. List any other names used. B. Enter Given Name (First Name) | Text |
Enter the given name (first name) of the juvenile if they have used any other names. This field is only applicable if you are filing for a Special Immigrant Juvenile.
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| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. 1. List any other names used. B. Enter Family Name (Last Name) | Text |
Enter the family name (last name) of the juvenile if they have used any other names. This field is only applicable if you are filing for a Special Immigrant Juvenile.
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| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information about the Juvenile. 1. List any other names used. A. Enter Middle Name | Text |
Enter the middle name of the juvenile if they have used any other names. This field is only applicable if you are filing for a Special Immigrant Juvenile.
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| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information about the Juvenile. 1. List any other names used. A. Enter Given Name (First Name) | Text |
Enter the given name (first name) of the juvenile if they have used any other names. This field is only applicable if you are filing for a Special Immigrant Juvenile.
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| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. 1. List any other names used. A. Enter Family Name (Last Name) | Text |
Enter the family name (last name) of the juvenile if they have used any other names. This field is only applicable if you are filing for a Special Immigrant Juvenile.
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| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. Answer the following questions regarding the person for whom the petition is being filed. If you answer "No" to Item. A. in Item Number 2., provide an explanation in the space provided in Part 15. Additional Information. 2. A. Have you been declared dependent on a juvenile court in the United States OR has a juvenile court legally committed you to, or placed you under the custody of, an agency, department of a state, or an individual or entity? Select No | CheckBox |
Select 'No' if the juvenile has not been declared dependent on a juvenile court in the United States or has not been legally committed to, or placed under the custody of, an agency, department of a state, or an individual or entity. Provide an explanation in Part 15 if you select 'No'. This field is only applicable if you are filing for a Special Immigrant Juvenile.
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| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. Answer the following questions regarding the person for whom the petition is being filed. If you answer "No" to Item. A. in Item Number 2., provide an explanation in the space provided in Part 15. Additional Information. 2. A. Have you been declared dependent on a juvenile court in the United States OR has a juvenile court legally committed you to, or placed you under the custody of, an agency, department of a state, or an individual or entity? Select Yes | CheckBox |
Select 'Yes' if the juvenile has been declared dependent on a juvenile court in the United States or has been legally committed to, or placed under the custody of, an agency, department of a state, or an individual or entity. This field is only applicable if you are filing for a Special Immigrant Juvenile.
|
| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. Provide the name of the state agency, department, or court-appointed organization or individual with which you are placed below | Text |
Provide the name of the state agency, department, or court-appointed organization or individual with which you are placed.
|
| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. 2. C. Are you currently under the jurisdiction of the juvenile court that made your placement or custody determination identified in Item B. in Item Number 2. above? Select Yes | CheckBox |
Indicate if you are currently under the jurisdiction of the juvenile court that made your placement or custody determination.
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| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. 2. C. Are you currently under the jurisdiction of the juvenile court that made your placement or custody determination identified in Item B. in Item Number 2. above? Select No | CheckBox |
Indicate if you are not currently under the jurisdiction of the juvenile court that made your placement or custody determination.
|
| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. 6. A. Are you currently or were you previously in the custody of the U.S. Department of Health and Human Services (H H S)? Select Yes | CheckBox |
Indicate if you are currently or were previously in the custody of the U.S. Department of Health and Human Services (HHS).
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| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. 6. B. If you answered "Yes" to Item A. in Item Number 6., and you are in H H S custody, did the juvenile court order determine or alter your custody status or placement? Select No | CheckBox |
If you answered 'Yes' to being in HHS custody, indicate if the juvenile court order determined or altered your custody status or placement.
|
| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. 6. B. If you answered "Yes" to Item A. in Item Number 6., and you are in H H S custody, did the juvenile court order determine or alter your custody status or placement? Select Yes | CheckBox |
If you answered 'Yes' to being in HHS custody, indicate if the juvenile court order determined or altered your custody status or placement.
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| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. 6. A. Are you currently or were you previously in the custody of the U.S. Department of Health and Human Services (H H S)? Select No | CheckBox |
Indicate if you are not currently or were not previously in the custody of the U.S. Department of Health and Human Services (HHS).
|
| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. 4. A. A juvenile court has determined that reunification is not viable due to: abuse, neglect, abandonment or similar basis under state law. Select one of my parents | CheckBox |
Indicate if a juvenile court has determined that reunification is not viable due to abuse, neglect, abandonment, or a similar basis under state law.
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| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. 4. A. A juvenile court has determined that reunification is not viable due to: abuse, neglect, abandonment or similar basis under state law. Select both of my parents | CheckBox |
Select this checkbox if a juvenile court has determined that reunification is not viable due to abuse, neglect, abandonment, or a similar basis under state law for both of your parents.
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| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. 4. A. A juvenile court has determined that reunification with one or both of my parents is not viable due to. Similar basis under state law (specify). Enter Specification | Text |
Specify the similar basis under state law that makes reunification with one or both of your parents not viable, as determined by a juvenile court.
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| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. 5. Has it been determined in judicial or administrative proceedings that it would not be in your best interest to be returned to your or your parent's country of citizenship or nationality or last habitual residence? Select Yes | CheckBox |
Select this checkbox if it has been determined in judicial or administrative proceedings that it would not be in your best interest to be returned to your or your parent's country of citizenship, nationality, or last habitual residence.
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| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. 3. A. If you answered "Yes" to Item C. in Item Number 2. above, are you currently residing in your court-ordered placement? Select No | CheckBox |
Select this checkbox if you are not currently residing in your court-ordered placement, as per your answer to Item C in Item Number 2.
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| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. 3. A. If you answered "Yes" to Item C. in Item Number 2. above, are you currently residing in your court-ordered placement? Select Yes | CheckBox |
Select this checkbox if you are currently residing in your court-ordered placement, as per your answer to Item C in Item Number 2.
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| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. 5. Has it been determined in judicial or administrative proceedings that it would not be in your best interest to be returned to your or your parent's country of citizenship or nationality or last habitual residence? Select No | CheckBox |
Select this checkbox if it has been determined in judicial or administrative proceedings that it would be in your best interest to be returned to your or your parent's country of citizenship, nationality, or last habitual residence.
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| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. 3. B. If you answered "No" to Item C. in Item Number 2. above, select your reason below. Select You were adopted or placed in a permanent guardianship or another permanent living arrangement (other than reunification with the abusive parents) | CheckBox |
Select this checkbox if you were adopted or placed in a permanent guardianship or another permanent living arrangement (other than reunification with the abusive parents), as per your answer to Item C in Item Number 2.
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| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. 4. A. A juvenile court has determined that reunification with one or both of my parents is not viable due to. Select Abuse | CheckBox |
Select this checkbox if a juvenile court has determined that reunification with one or both of your parents is not viable due to abuse.
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| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. 4. A. A juvenile court has determined that reunification with one or both of my parents is not viable due to. Select Similar basis under state law (specify) | CheckBox |
Select this checkbox if a juvenile court has determined that reunification with one or both of your parents is not viable due to a similar basis under state law. Specify the basis in the provided space.
|
| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. 4. A. A juvenile court has determined that reunification with one or both of my parents is not viable due to. Select Neglect | CheckBox |
Select this checkbox if a juvenile court has determined that reunification with one or both of your parents is not viable due to neglect.
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| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. 4. A. A juvenile court has determined that reunification with one or both of my parents is not viable due to. Select Abandonment | CheckBox |
Select this checkbox if a juvenile court has determined that reunification with one or both of your parents is not viable due to abandonment.
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| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. 4. B. If you selected "one" in Item A. in Item Number 4., provide the name of that parent | Text |
If you selected 'one' in Item A of Item Number 4, provide the name of the parent with whom reunification is not viable.
|
| Special Immigrant Juvenile Petition | ||
| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. 3. B. If you answered "No" to Item C. in Item Number 2. above, select your reason below. Select You aged-out of the juvenile court's jurisdiction and the order was terminated based on age | CheckBox |
Select this option if you aged-out of the juvenile court's jurisdiction and the order was terminated based on age, in case you answered 'No' to Item C. in Item Number 2.
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| Part 8. Complete Only If Filing for a Special Immigrant Juvenile. Information About the Juvenile. 3. B. If you answered "No" to Item C. in Item Number 2. above, select your reason below. Select Other. (If you selected "Other," provide an explanation in the space provided in Part 15. Additional Information.) | CheckBox |
Select 'Other' if your reason for answering 'No' to Item C. in Item Number 2. does not fit the provided options. Provide an explanation in the space provided in Part 15. Additional Information.
|
| Special Immigrant Religious Worker Petition | ||
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Prospective Employer Attestation. 1. Provide the following information about the prospective employer. A. Enter Number of members of the prospective employer's organization | Number |
Enter the number of members in the prospective employer's organization.
|
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Prospective Employer Attestation. 1. Provide the following information about the prospective employer. B. Enter Number of employees working at the same location where the beneficiary will be employed | Number |
Enter the number of employees working at the same location where the beneficiary will be employed.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Prospective Employer Attestation. 1. Provide the following information about the prospective employer. C. Enter Number of aliens holding special immigrant or nonimmigrant religious worker status who are currently employed or were employed within the past five years | Number |
Enter the number of aliens holding special immigrant or nonimmigrant religious worker status who are currently employed or were employed within the past five years.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Prospective Employer Attestation. 1. Provide the following information about the prospective employer. D. Enter Number of Special Immigrant Religious Worker (Form I-3 60) and Nonimmigrant Religious Worker (Form I-1 29) petitions submitted by the prospective employer within the past five years | Number |
Enter the number of Special Immigrant Religious Worker (Form I-360) and Nonimmigrant Religious Worker (Form I-129) petitions submitted by the prospective employer within the past five years.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Prospective Employer Attestation. 1. Provide the following information about the prospective employer: E. Enter Number of Special Immigrant Religious Worker (Form I-3 60) petitions submitted by the beneficiary during the last five years | Number |
Enter the number of Special Immigrant Religious Worker (Form I-360) petitions submitted by the beneficiary during the last five years.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Prospective Employer Attestation. 2. Has the beneficiary or have any of the beneficiary's dependent family members previously been admitted to the United States for a period of stay in the Religious Worker (R) classification during the last five years? Select No | CheckBox |
Select 'No' if the beneficiary or any of the beneficiary's dependent family members have not been admitted to the United States for a period of stay in the Religious Worker (R) classification during the last five years.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Prospective Employer Attestation. 2. Has the beneficiary or have any of the beneficiary's dependent family members previously been admitted to the United States for a period of stay in the Religious Worker (R) classification during the last five years? Select Yes. If you answered "Yes" to Item Number 2., provide the beneficiary's and any dependent family member's prior periods of stay in the R classification in the United States during the last five years. Be sure to provide only those periods when the beneficiary and/or family members were actually in the United States in the R classification. Provide the beneficiary's information in Item Number 3. below. For dependent family members, use the space provided in Part 15. Additional Information | CheckBox |
Select 'Yes' if the beneficiary or any of the beneficiary's dependent family members have been admitted to the United States for a period of stay in the Religious Worker (R) classification during the last five years. If 'Yes', provide the beneficiary's and any dependent family member's prior periods of stay in the R classification in the United States during the last five years.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 4. Provide a summary of the type of responsibilities of those employees, other than the beneficiary, who work at the same location where the beneficiary will be employed. If you need extra space to complete this section use the space provided in Part 15. Additional Information. Enter Position | Text |
Provide a summary of the type of responsibilities of those employees, other than the beneficiary, who work at the same location where the beneficiary will be employed. Use the space provided in Part 15. Additional Information if needed.
|
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 6. B. The beneficiary will be working (select one of the following). Select As a minister | CheckBox |
Select this checkbox if the beneficiary will be working as a minister.
|
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 6. B. The beneficiary will be working (select one of the following). Select In a religious vocation | CheckBox |
Select this checkbox if the beneficiary will be working in a religious vocation.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 6. B. The beneficiary will be working (select one of the following). Select In a religious occupation | CheckBox |
Select this checkbox if the beneficiary will be working in a religious occupation.
|
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 3. Beneficiary. Period of Stay. Enter From Date. Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Date |
Enter the start date of the beneficiary's period of stay in the format MM/DD/YYYY.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 3. Beneficiary. Period of Stay. Enter To Date. Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Date |
Enter the end date of the beneficiary's period of stay in the format MM/DD/YYYY.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 3. Beneficiary. Enter Middle Name | Text |
Enter the beneficiary's middle name.
|
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 3. Beneficiary. Enter Given Name (First Name) | Text |
Enter the beneficiary's given name (first name).
|
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 3. Beneficiary. Enter Family Name (Last Name) | Text |
Enter the beneficiary's family name (last name).
|
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Answer Item Numbers 7. through 13. about the prospective employer. If you answer "No" for Item Numbers 7. through 13., provide an explanation in the space provided in Part 15. Additional Information. 7. The prospective employer is a bona fide non-profit religious organization or a bona fide organization that is affiliated with the religious denomination and is tax exempt as described in section 501(c)(3) of the Internal Revenue Code of 1986, subsequent amendment, or equivalent sections of prior enactments of the Internal Revenue Code. If the prospective employer is affiliated with the religious denomination, complete the Religious Denomination Certification included in this petition. Select No | CheckBox |
Select this checkbox if the prospective employer is not a bona fide non-profit religious organization or a bona fide organization affiliated with the religious denomination and tax-exempt under section 501(c)(3) of the Internal Revenue Code.
|
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Answer Item Numbers 7. through 13. about the prospective employer. If you answer "No" for Item Numbers 7. through 13., provide an explanation in the space provided in Part 15. Additional Information. 7. The prospective employer is a bona fide non-profit religious organization or a bona fide organization that is affiliated with the religious denomination and is tax exempt as described in section 501(c)(3) of the Internal Revenue Code of 1986, subsequent amendment, or equivalent sections of prior enactments of the Internal Revenue Code. If the prospective employer is affiliated with the religious denomination, complete the Religious Denomination Certification included in this petition. Select Yes | CheckBox |
Indicate whether the prospective employer is a bona fide non-profit religious organization or a bona fide organization affiliated with the religious denomination and is tax-exempt as described in section 501(c)(3) of the Internal Revenue Code. If 'No', provide an explanation in Part 15.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 7. If you answered "Yes," select the applicable box and attach the appropriate documentation to the petition. A. Select A currently valid determination letter from the Internal Revenue Service (I R S) establishing that the organization is a tax-exempt organization | CheckBox |
If you answered 'Yes' to the previous question, select this box if you have a currently valid determination letter from the IRS establishing that the organization is a tax-exempt organization. Attach the appropriate documentation to the petition.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 7. If you answered "Yes," select the applicable box and attach the appropriate documentation to the petition. B. Select A currently valid determination letter from the I R S establishing that the organization is recognized as tax-exempt under a group tax exemption | CheckBox |
If you answered 'Yes' to the previous question, select this box if you have a currently valid determination letter from the IRS establishing that the organization is recognized as tax-exempt under a group tax exemption. Attach the appropriate documentation to the petition.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 7. If you answered "Yes," select the applicable box and attach the appropriate documentation to the petition. C. Select If you are claiming that the prospective employer is a bona fide organization that is affiliated with the religious denomination, provide the following | CheckBox |
If you answered 'Yes' to the previous question, select this box if you are claiming that the prospective employer is a bona fide organization affiliated with the religious denomination. Provide the following documentation.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 7. If you answered "Yes," select the applicable box and attach the appropriate documentation to the petition. C. If you are claiming that the prospective employer is a bona fide organization that is affiliated with the religious denomination, provide the following. 1. Select A currently valid determination letter from the I R S establishing that the organization is a tax-exempt organization | CheckBox |
If you are claiming that the prospective employer is a bona fide organization affiliated with the religious denomination, select this box if you have a currently valid determination letter from the IRS establishing that the organization is a tax-exempt organization. Attach the appropriate documentation to the petition.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 7. If you answered "Yes," select the applicable box and attach the appropriate documentation to the petition. C. If you are claiming that the prospective employer is a bona fide organization that is affiliated with the religious denomination, provide the following. 2. Select Documentation that establishes the religious nature and purpose of the organization, such as a copy of the organizing instrument of the organization that specifies the purposes of the organization | CheckBox |
If you are claiming that the prospective employer is a bona fide organization affiliated with the religious denomination, select this box if you have documentation that establishes the religious nature and purpose of the organization, such as a copy of the organizing instrument of the organization that specifies the purposes of the organization. Attach the appropriate documentation to the petition.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 7. If you answered "Yes," select the applicable box and attach the appropriate documentation to the petition. C. If you are claiming that the prospective employer is a bona fide organization that is affiliated with the religious denomination, provide the following. 3. Select Organizational literature, such as books, articles, brochures, calendars, flyers, and other literature describing the religious purpose and nature of the activities of the organization | CheckBox |
Select this checkbox if you are claiming that the prospective employer is a bona fide organization affiliated with the religious denomination and provide organizational literature such as books, articles, brochures, calendars, flyers, and other literature describing the religious purpose and nature of the activities of the organization.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 7. If you answered "Yes," select the applicable box and attach the appropriate documentation to the petition. C. If you are claiming that the prospective employer is a bona fide organization that is affiliated with the religious denomination, provide the following. 4. Select A completed religious denomination certification, signed and dated, certifying that the petitioning organization is affiliated with the religious denomination | CheckBox |
Select this checkbox if you are providing a completed religious denomination certification, signed and dated, certifying that the petitioning organization is affiliated with the religious denomination.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 8. The prospective employer is willing and able to provide salaried and/or non-salaried compensation at a level that the beneficiary and any dependents will not become a public charge. Select Yes | CheckBox |
Select 'Yes' if the prospective employer is willing and able to provide salaried and/or non-salaried compensation at a level that ensures the beneficiary and any dependents will not become a public charge.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 8. The prospective employer is willing and able to provide salaried and/or non-salaried compensation at a level that the beneficiary and any dependents will not become a public charge. Select No | CheckBox |
Select 'No' if the prospective employer is not willing or able to provide salaried and/or non-salaried compensation at a level that ensures the beneficiary and any dependents will not become a public charge.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 9. The funds to pay the beneficiary's compensation do not include any monies obtained from the beneficiary, excluding reasonable donations or tithing to the religious organization. Select No | CheckBox |
Select 'No' if the funds to pay the beneficiary's compensation do not include any monies obtained from the beneficiary, excluding reasonable donations or tithing to the religious organization.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 9. The funds to pay the beneficiary's compensation do not include any monies obtained from the beneficiary, excluding reasonable donations or tithing to the religious organization. Select Yes | CheckBox |
Select 'Yes' if the funds to pay the beneficiary's compensation do not include any monies obtained from the beneficiary, excluding reasonable donations or tithing to the religious organization.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 10. The beneficiary will not engage in secular employment, and the prospective employer will provide salaried and/or non-salaried compensation. Select Yes | CheckBox |
Select 'Yes' if the beneficiary will not engage in secular employment and the prospective employer will provide salaried and/or non-salaried compensation.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 12. The beneficiary has been a religious worker for at least two years immediately before Form I-3 60 was filed and is otherwise qualified for the position offered. Select Yes | CheckBox |
Select 'Yes' if the beneficiary has been a religious worker for at least two years immediately before Form I-360 was filed and is otherwise qualified for the position offered.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 13. The beneficiary has been a member of the prospective employer's denomination for at least two years immediately before Form I-3 60 was filed. Select No | CheckBox |
Indicate whether the beneficiary has been a member of the prospective employer's denomination for at least two years immediately before Form I-360 was filed. Select 'No' if this is not the case.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 13. The beneficiary has been a member of the prospective employer's denomination for at least two years immediately before Form I-3 60 was filed. Select Yes | CheckBox |
Indicate whether the beneficiary has been a member of the prospective employer's denomination for at least two years immediately before Form I-360 was filed. Select 'Yes' if this is the case.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 12. The beneficiary has been a religious worker for at least two years immediately before Form I-3 60 was filed and is otherwise qualified for the position offered. Select No | CheckBox |
Indicate whether the beneficiary has been a religious worker for at least two years immediately before Form I-360 was filed and is otherwise qualified for the position offered. Select 'No' if this is not the case.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 11. The offered position is full time, requiring at least an average of 35 hours of work per week. Select No | CheckBox |
Indicate whether the offered position is full-time, requiring at least an average of 35 hours of work per week. Select 'No' if this is not the case.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 11. The offered position is full time, requiring at least an average of 35 hours of work per week. Select Yes | CheckBox |
Indicate whether the offered position is full-time, requiring at least an average of 35 hours of work per week. Select 'Yes' if this is the case.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 10. The beneficiary will not engage in secular employment, and the prospective employer will provide salaried and/or non-salaried compensation. Select No | CheckBox |
Indicate whether the beneficiary will not engage in secular employment, and the prospective employer will provide salaried and/or non-salaried compensation. Select 'No' if this is not the case.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Printed Name and Title of Signatory for Prospective Employer. 16. Enter Title of the Signatory | Text |
Enter the title of the signatory for the prospective employer. This is required only if you are filing a Special Immigrant Religious Worker Petition.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Mailing Address. 17. Enter Employer / Organization Name | Text |
Enter the name of the employer or organization. This is required only if you are filing a Special Immigrant Religious Worker Petition.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Mailing Address. 17. Enter Street Number and Name | Text |
Enter the street number and name of the employer or organization. This is required only if you are filing a Special Immigrant Religious Worker Petition.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Mailing Address. 17. Select Suite | CheckBox |
Select this checkbox if the address includes a suite. This is required only if you are filing a Special Immigrant Religious Worker Petition.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Mailing Address. 17. Select Apartment | CheckBox |
Select this checkbox if the address includes an apartment. This is required only if you are filing a Special Immigrant Religious Worker Petition.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Mailing Address. 17. Select Floor | CheckBox |
Select this checkbox if the address includes a floor. This is required only if you are filing a Special Immigrant Religious Worker Petition.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Mailing Address. 17. Enter Apartment, Suite or Floor Number | Text |
Enter the apartment, suite, or floor number. This is required only if you are filing a Special Immigrant Religious Worker Petition.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. Mailing Address. 17. Enter City or Town | Text |
Enter the city or town of the employer or organization. This is required only if you are filing a Special Immigrant Religious Worker Petition.
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| Spouse and Children Information | ||
| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 2. Person One. Enter Alien Registration Number (A. Number), if any | Number |
Enter the Alien Registration Number (A. Number) for the first person listed as a spouse or child of the person for whom this petition is being filed, if any. The number should be up to 9 digits long.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 2. Person One. Enter Country of Birth | Text |
Enter the country of birth for the first person listed as a spouse or child of the person for whom this petition is being filed.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 2. Person One. Enter Date of Birth. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
Enter the date of birth for the first person listed as a spouse or child of the person for whom this petition is being filed. Use the format MM/DD/YYYY.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 2. Person One. Enter Family Name (Last Name) | Text |
Enter the family name (last name) for the first person listed as a spouse or child of the person for whom this petition is being filed.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 2. Person One. Enter Given Name (First Name) | Text |
Enter the given name (first name) for the first person listed as a spouse or child of the person for whom this petition is being filed.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 2. Person One. Enter Middle Name | Text |
Enter the middle name for the first person listed as a spouse or child of the person for whom this petition is being filed.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 2. Person One. Relationship. Select Spouse | CheckBox |
Select this checkbox if the first person listed as a spouse or child of the person for whom this petition is being filed is a spouse.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 2. Person One. Relationship. Select Child | CheckBox |
Select this checkbox if the first person listed as a spouse or child of the person for whom this petition is being filed is a child.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. NOTE: Depending on the classification you seek, you can either file this petition for another person or for yourself. On this petition, the "beneficiary" or "self-petitioner" means the person for whom this petition is being filed, whether that person is yourself or another person. 1. If you are filing as a self-petitioning spouse, have any of your children filed separate self-petitions? Select Yes | CheckBox |
Indicate whether any of your children have filed separate self-petitions if you are filing as a self-petitioning spouse. Select 'Yes' if applicable.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 1. If you are filing as a self-petitioning spouse, have any of your children filed separate self-petitions? Select No | CheckBox |
Indicate whether any of your children have filed separate self-petitions if you are filing as a self-petitioning spouse. Select 'No' if applicable.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 3. Person Two. Enter Alien Registration Number (A. Number), if any | Number |
Enter the Alien Registration Number (A. Number) for Person Two, if any.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 3. Person Two. Relationship. Select Child | CheckBox |
Select 'Child' to indicate the relationship of Person Two to the petitioner.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 3. Person Two. Enter Country of Birth | Text |
Enter the country of birth for Person Two.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 3. Person Two. Enter Date of Birth. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
Enter the date of birth for Person Two in the format MM/DD/YYYY.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 3. Person Two. Enter Family Name (Last Name) | Text |
Enter the family name (last name) for Person Two.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 3. Person Two. Enter Given Name (First Name) | Text |
Enter the given name (first name) for Person Two.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 3. Person Two. Enter Middle Name | Text |
Enter the middle name of the second person (spouse or child) for whom this petition is being filed.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 4. Person Three. Enter Alien Registration Number (A. Number), if any | Number |
Enter the Alien Registration Number (A. Number) of the third person (spouse or child) for whom this petition is being filed, if they have one. The number should be up to 9 digits long.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 4. Person Three. Relationship. Select Child | CheckBox |
Select this checkbox if the third person for whom this petition is being filed is a child.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 4. Person Three. Enter Country of Birth | Text |
Enter the country of birth of the third person (spouse or child) for whom this petition is being filed.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 4. Person Three. Enter Date of Birth. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
Enter the date of birth of the third person (spouse or child) for whom this petition is being filed. Use the format MM/DD/YYYY.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 4. Person Three. Enter Family Name (Last Name) | Text |
Enter the family name (last name) of the third person (spouse or child) for whom this petition is being filed.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 4. Person Three. Enter Given Name (First Name) | Text |
Enter the given name (first name) of the third person (spouse or child) for whom this petition is being filed.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 4. Person Three. Enter Middle Name | Text |
Enter the middle name of the third person (spouse or child) for whom this petition is being filed.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 5. Person Four. Enter Alien Registration Number (A. Number), if any | Number |
Enter the Alien Registration Number (A. Number) of the fourth person (spouse or child) for whom this petition is being filed, if they have one. The number should be up to 9 digits long.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 5. Person Four. Relationship. Select Child | CheckBox |
Select this checkbox if the fourth person for whom this petition is being filed is a child.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 5. Person Four. Enter Country of Birth | Text |
Enter the country of birth for the fourth person listed in the spouse and children section of the petition.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 5. Person Four. Enter Date of Birth. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
Enter the date of birth for the fourth person listed in the spouse and children section of the petition. Use the format MM/DD/YYYY.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 5. Person Four. Enter Family Name (Last Name) | Text |
Enter the family name (last name) for the fourth person listed in the spouse and children section of the petition.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 5. Person Four. Enter Given Name (First Name) | Text |
Enter the given name (first name) for the fourth person listed in the spouse and children section of the petition.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 5. Person Four. Enter Middle Name | Text |
Enter the middle name for the fourth person listed in the spouse and children section of the petition.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 6. Person Five. Enter Alien Registration Number (A. Number), if any | Number |
Enter the Alien Registration Number (A-Number), if any, for the fifth person listed in the spouse and children section of the petition. The number should be up to 9 digits long.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 6. Person Five. Relationship. Select Child | CheckBox |
Select this checkbox if the fifth person listed in the spouse and children section of the petition is a child.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 6. Person Five. Enter Country of Birth | Text |
Enter the country of birth for the fifth person listed in the spouse and children section of the petition.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 6. Person Five. Enter Date of Birth. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
Enter the date of birth for the fifth person listed in the spouse and children section of the petition. Use the format MM/DD/YYYY.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 6. Person Five. Enter Family Name (Last Name) | Text |
Enter the family name (last name) for the fifth person listed in the spouse and children section of the petition.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 6. Person Five. Enter Given Name (First Name) | Text |
Enter the given name (first name) of the fifth person (spouse or child) for whom this petition is being filed.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 6. Person Five. Enter Middle Name | Text |
Enter the middle name of the fifth person (spouse or child) for whom this petition is being filed.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 7. Person Six. Enter Alien Registration Number (A. Number), if any | Number |
Enter the Alien Registration Number (A. Number), if any, of the sixth person (spouse or child) for whom this petition is being filed. The number should be up to 9 digits long.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 7. Person Six. Relationship. Select Child | CheckBox |
Select this checkbox if the sixth person for whom this petition is being filed is a child.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 7. Person Six. Enter Country of Birth | Text |
Enter the country of birth of the sixth person (spouse or child) for whom this petition is being filed.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 7. Person Six. Enter Date of Birth. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
Enter the date of birth of the sixth person (spouse or child) for whom this petition is being filed. Use the format MM/DD/YYYY.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 7. Person Six. Enter Family Name (Last Name) | Text |
Enter the family name (last name) of the sixth person (spouse or child) for whom this petition is being filed.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 7. Person Six. Enter Given Name (First Name) | Text |
Enter the given name (first name) of the sixth person (spouse or child) for whom this petition is being filed.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 7. Person Six. Enter Middle Name | Text |
Enter the middle name of the sixth person (spouse or child) for whom this petition is being filed.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 8. Person Seven. Enter Alien Registration Number (A. Number), if any | Number |
Enter the Alien Registration Number (A. Number), if any, for Person Seven in the section about the spouse and children of the person for whom this petition is being filed.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 8. Person Seven. Relationship. Select Child | CheckBox |
Select the relationship of Person Seven to the person for whom this petition is being filed. Choose 'Child' if applicable.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 8. Person Seven. Enter Country of Birth | Text |
Enter the country of birth for Person Seven.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 8. Person Seven. Enter Date of Birth. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
Enter the date of birth for Person Seven in the format MM/DD/YYYY.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 8. Person Seven. Enter Family Name (Last Name) | Text |
Enter the family name (last name) of Person Seven.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 8. Person Seven. Enter Given Name (First Name) | Text |
Enter the given name (first name) of Person Seven.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 8. Person Seven. Enter Middle Name | Text |
Enter the middle name of Person Seven.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 9. Person Eight. Relationship. Select Child | CheckBox |
Select the relationship of Person Eight to the person for whom this petition is being filed. Choose 'Child' if applicable.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 9. Person Eight. Enter Country of Birth | Text |
Enter the country of birth for Person Eight.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 9. Person Eight. Enter Date of Birth. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
Enter the date of birth for Person Eight in the format MM/DD/YYYY.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 9. Person Eight. Enter Family Name (Last Name) | Text |
Enter the family name (last name) of Person Eight.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 9. Person Eight. Enter Given Name (First Name) | Text |
Enter the given name (first name) of Person Eight.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 9. Person Eight. Enter Middle Name | Text |
Enter the middle name of the eighth person (spouse or child) for whom this petition is being filed.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 10. Person Nine. Enter Alien Registration Number (A. Number), if any | Number |
Enter the Alien Registration Number (A. Number), if any, for the ninth person (spouse or child) for whom this petition is being filed. The number should be up to 9 digits long.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 10. Person Nine. Relationship. Select Child | CheckBox |
Select this checkbox if the ninth person (spouse or child) for whom this petition is being filed is a child.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 10. Person Nine. Enter Country of Birth | Text |
Enter the country of birth for the ninth person (spouse or child) for whom this petition is being filed.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 10. Person Nine. Enter Date of Birth. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
Enter the date of birth for the ninth person (spouse or child) for whom this petition is being filed. Use the format MM/DD/YYYY.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 10. Person Nine. Enter Family Name (Last Name) | Text |
Enter the family name (last name) of the ninth person (spouse or child) for whom this petition is being filed.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 10. Person Nine. Enter Given Name (First Name) | Text |
Enter the given name (first name) of the ninth person (spouse or child) for whom this petition is being filed.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 10. Person Nine. Enter Middle Name | Text |
Enter the middle name of the ninth person (spouse or child) for whom this petition is being filed.
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| Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed. 9. Person Eight. Enter Alien Registration Number (A. Number), if any | Number |
Enter the Alien Registration Number (A. Number), if any, for the eighth person (spouse or child) for whom this petition is being filed. The number should be up to 9 digits long.
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| Spouse Information | ||
| Part 7. Complete Only If Filing as a Widow / Widower. 5. At time of death, your spouse was a (Select only one). C. U.S. citizen through naturalization. 1. If you select this box, Provide Alien Registration Number (A. Number), if any | Text |
Provide the Alien Registration Number (A. Number) of your spouse if they were a U.S. citizen through naturalization at the time of their death.
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| Part 7. Complete Only If Filing as a Widow / Widower. 7. How many times was your spouse married? Enter the number here | Text |
Enter the number of times your spouse was married.
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| Statement | ||
| Part 12. Statement, Contact Information, Declaration, and Signature of the Petitioner or Authorized Signatory. Petitioner's or Authorized Signatory's Statement. NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2. 2. Petitioner's Statement Regarding the Preparer. Select At my request, the preparer named in Part 14., prepared this petition for me based only upon information I provided or authorized | CheckBox |
Select this checkbox if the preparer named in Part 14 prepared this petition based on information provided or authorized by the petitioner.
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| Part 12. Statement, Contact Information, Declaration, and Signature of the Petitioner or Authorized Signatory. Petitioner's or Authorized Signatory's Statement. NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2. 2. Petitioner's Statement Regarding the Preparer. Enter Name of Preparer | Text |
Enter the name of the preparer who helped fill out this petition, if applicable.
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| Travel Document Information | ||
| Part 3. Information About the Person for Whom This Petition Is Being Filed. Other Information. 11. Enter Travel Document Number | Text |
Enter the travel document number of the person for whom this petition is being filed.
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| Part 3. Information About the Person for Whom This Petition Is Being Filed. Other Information. 12. Enter Country of Issuance for Passport or Travel Document | Text |
Enter the country where the passport or travel document was issued.
|
| VAWA Self-Petitioning Information | ||
| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 4. Enter Date of Death. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
Enter the date of death in the format MM/DD/YYYY for the VAWA self-petitioning spouse, child, or parent.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 6. How many times have you been married? Enter the number here | Text |
Enter the number of times you have been married. This field is required if you are filing as a VAWA self-petitioning spouse or child of a U.S. citizen or lawful permanent resident, or as a VAWA self-petitioning parent of a U.S. citizen son or daughter.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 7. How many times was your abuser married (if known)? Enter the number here | Text |
Enter the number of times your abuser has been married, if known. This field is required if you are filing as a VAWA self-petitioning spouse or child of a U.S. citizen or lawful permanent resident, or as a VAWA self-petitioning parent of a U.S. citizen son or daughter.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 5. Your abuser is now, or was, a (Select one). C. U.S. citizen through naturalization. 1. Provide. A. Number (if known) | Text |
Provide the A-Number of your abuser if they are a U.S. citizen through naturalization, if known. This field is required if you are filing as a VAWA self-petitioning spouse or child of a U.S. citizen or lawful permanent resident, or as a VAWA self-petitioning parent of a U.S. citizen son or daughter.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 9. When did you live with your abuser? Enter From Date. Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Date |
Enter the date you started living with your abuser. Use the format MM/DD/YYYY. This field is required if you are filing as a VAWA self-petitioning spouse or child of a U.S. citizen or lawful permanent resident, or as a VAWA self-petitioning parent of a U.S. citizen son or daughter.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 9. When did you live with your abuser? Enter To Date. Enter as 2-digit Month, 2-digit Day, and 4-digit Year. Include any other dates you have lived off/on with your abuser in the space provided in Part 15. Additional Information | Date |
Enter the date you stopped living with your abuser. Use the format MM/DD/YYYY. Include any other dates you have lived off/on with your abuser in the space provided in Part 15. Additional Information. This field is required if you are filing as a VAWA self-petitioning spouse or child of a U.S. citizen or lawful permanent resident, or as a VAWA self-petitioning parent of a U.S. citizen son or daughter.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 11. Provide the last date that you lived together with your abuser at this address. Enter To Date. Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Date |
Provide the last date that you lived together with your abuser at this address. Enter the date in the format MM/DD/YYYY.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 11. Provide the last date that you lived together with your abuser at this address. Enter From Date. Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Date |
Provide the first date that you lived together with your abuser at this address. Enter the date in the format MM/DD/YYYY.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 12. I am currently residing in the United States and I request an Employment Authorization Document. Select Yes | CheckBox |
Select this checkbox if you are currently residing in the United States and you request an Employment Authorization Document.
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| Part 10. Complete Only If Filing as a V. A. W. A. Self-Petitioning Spouse or Child of a U.S. Citizen or Lawful Permanent Resident or a V. A. W. A. Self-Petitioning Parent of a U.S. Citizen Son or Daughter. 12. I am currently residing in the United States and I request an Employment Authorization Document. Select No | CheckBox |
Select this checkbox if you do not request an Employment Authorization Document.
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| Widow/Widower Information | ||
| Part 7. Complete Only If Filing as a Widow / Widower. 1. Full Name of U.S. Citizen Husband or Wife Who Died. Enter Given Name (First Name) | Text |
Enter the given name (first name) of your deceased U.S. citizen husband or wife.
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| Part 7. Complete Only If Filing as a Widow / Widower. 1. Full Name of U.S. Citizen Husband or Wife Who Died. Enter Family Name (Last Name) | Text |
Enter the family name (last name) of your deceased U.S. citizen husband or wife.
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| Part 7. Complete Only If Filing as a Widow / Widower. 4. Enter Date of Death. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
Enter the date of death of your deceased U.S. citizen husband or wife in the format MM/DD/YYYY.
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| Part 7. Complete Only If Filing as a Widow / Widower. 2. Enter Date of Birth. Enter as 2 digit month, 2 digit day and 4 digit year | Date |
Enter the date of birth of your deceased U.S. citizen husband or wife in the format MM/DD/YYYY.
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| Part 7. Complete Only If Filing as a Widow / Widower. 3. Enter Country of Birth | Text |
Enter the country of birth of your deceased U.S. citizen husband or wife.
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| Part 7. Complete Only If Filing as a Widow / Widower. 6. How many times have you been married? Enter the number here | Text |
Enter the number of times you have been married. This field is only applicable if you are filing as a widow or widower.
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| Widow/Widower Petition | ||
| Part 7. Complete Only If Filing as a Widow / Widower. 1. Full Name of U.S. Citizen Husband or Wife Who Died. Enter Middle Name | Text |
Enter the middle name of the U.S. citizen husband or wife who died, if filing as a widow or widower.
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| Part 7. Complete Only If Filing as a Widow / Widower. 5. At time of death, your spouse was a (Select only one). A. Select U.S. citizen born in the United States | CheckBox |
Select this option if your spouse was a U.S. citizen born in the United States at the time of their death.
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| Part 7. Complete Only If Filing as a Widow / Widower. 5. At time of death, your spouse was a (Select only one). B. Select U.S. citizen born abroad to U.S. citizen parents | CheckBox |
Select this option if your spouse was a U.S. citizen born abroad to U.S. citizen parents at the time of their death.
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| Part 7. Complete Only If Filing as a Widow / Widower. 5. At time of death, your spouse was a (Select only one). D. Select Other (Explain) | CheckBox |
Select this option if your spouse's status at the time of their death was 'Other' and provide an explanation.
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| Part 7. Complete Only If Filing as a Widow / Widower. 5. At time of death, your spouse was a (Select only one). D. Other. Enter Explanation | Text |
Provide an explanation if you selected 'Other' for your spouse's status at the time of their death.
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| Part 7. Complete Only If Filing as a Widow / Widower. 5. At time of death, your spouse was a (Select only one). C. Select U.S. citizen through naturalization | CheckBox |
Select this option if your spouse was a U.S. citizen through naturalization at the time of their death.
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| Work Location Details | ||
| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 6. F. Provide the specific addresses or locations where the beneficiary will be working. Select Floor | CheckBox |
Select the floor number where the beneficiary will be working.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 6. F. Provide the specific addresses or locations where the beneficiary will be working. Enter Apartment, Suite or Floor Number | Text |
Enter the apartment, suite, or floor number where the beneficiary will be working. Maximum length is 6 characters.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 6. F. Provide the specific addresses or locations where the beneficiary will be working. Enter City or Town | Text |
Enter the city or town where the beneficiary will be working. Maximum length is 20 characters.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 6. F. Provide the specific addresses or locations where the beneficiary will be working. Select State from List of States | ComboBox |
Select the state from the provided list where the beneficiary will be working.
OR
DE
UT
AZ
GA
NV
SD
MS
TX
IA
CA
WA
WY
FL
AE
WV
PA
AR
MD
NH
NC
AS
AA
ID
MA
DC
KS
MO
NY
LA
WI
AL
GU
MH
MN
AP
CT
NM
NJ
PR
IN
VA
FM
RI
OH
OK
HI
MT
VT
SC
MP
TN
CO
ME
ND
VI
KY
MI
AK
IL
PW
NE
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 6. F. Provide the specific addresses or locations where the beneficiary will be working. Enter Zip Code | Text |
Enter the ZIP code where the beneficiary will be working. Maximum length is 5 characters.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 6. F. Provide the specific addresses or locations where the beneficiary will be working. Enter Postal Code | Text |
Enter the postal code where the beneficiary will be working. Maximum length is 9 characters.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 6. F. Provide the specific addresses or locations where the beneficiary will be working. Enter Province | Text |
Enter the province where the beneficiary will be working. Maximum length is 20 characters.
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| Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition. 6. F. Provide the specific addresses or locations where the beneficiary will be working. Enter Country | Text |
Enter the country where the beneficiary will be working.
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