Form I-589, Application for Asylum and for Withholding of Removal Instructions

Use this field as a continuation page for any additional information requested. Enter the part number you are continuing.

Provide the question number from the form for which you are supplying additional information. Use this field if you need more space to elaborate on your answers related to your asylum claim.

Enter any additional information related to your asylum claim that you could not fit in the main sections of the form. This is a continuation page for elaborating on your responses.

Enter the 'From' date (month and year) for your last address before coming to the United States, or the last address in the country where you fear persecution.

Enter the 'To' date (month and year) for your last address before coming to the United States, or the last address in the country where you fear persecution.

Enter the 'To' date (month and year) for your last address before coming to the United States, or the last address in the country where you fear persecution.

Enter the city or town of your last address before coming to the United States. If applicable, also include the city or town of your last address in the country where you fear persecution.

Enter the department, province, or state of your last address before coming to the United States. If applicable, also include the department, province, or state of your last address in the country where you fear persecution.

Enter the department, province, or state of your last address before coming to the United States. If applicable, also include the department, province, or state of your last address in the country where you fear persecution.

Enter the country of your last address before coming to the United States. If applicable, also include the country of your last address in the country where you fear persecution.

Enter the country of your last address before coming to the United States. If applicable, also include the country of your last address in the country where you fear persecution.

Enter the 'From' date for your last address before coming to the United States in the format of 2-digit month and 2-digit year. If applicable, also include the 'From' date for your last address in the country where you fear persecution.

Sign your name to certify that the information in this application and the evidence submitted are true and correct. This form cannot be signed electronically.

Write your name in your native alphabet as part of the asylum interview process.

Provide the applicant's handwritten signature. Note that this form cannot be signed electronically and the name cannot be typewritten.

Enter the date in the format MM/DD/YYYY.

Enter the Alien Registration Number (A-Number) if available.

Enter the full name of the applicant.

Enter the date you signed the form in the format MM/DD/YYYY. This is your personal signature date.

Provide your handwritten signature during the asylum interview. The signature cannot be typewritten or electronic.

Indicate whether you have been provided with a list of persons who may be available to assist you, at little or no cost, with your asylum claim by selecting 'No'.

Indicate whether someone other than your spouse, parent, or child/children prepared this application by selecting 'No'.

Indicate whether your spouse, parent, or child/children assisted you in completing this application by selecting 'No'.

Indicate if you are seeking asylum or withholding of removal based on the Convention Against Torture by checking this box.

Indicate if you are seeking asylum or withholding of removal based on race by checking this box.

Indicate whether you fear harm or mistreatment if you return to your home country by selecting 'No'.

Indicate whether you, your family, or close friends or colleagues have ever experienced harm, mistreatment, or threats in the past by selecting 'No'.

Select 'Yes' if your spouse, who is in the U.S., should be included in this asylum application.

Select 'No' if your spouse, who is in the U.S., should not be included in this asylum application.

Select this checkbox if you want to include your first child, who is in the U.S., in this asylum application.

Select this checkbox if you do not want to include your first child, who is in the U.S., in this asylum application.

Check this box if you want to include Child 4 in this asylum application.

Check this box if you do not want to include Child 4 in this asylum application.

Select 'Yes' if you want to include this additional child in your asylum application.

Select 'No' if you do not want to include this additional child in your asylum application.

Check this box if you wish to apply for withholding of removal under the Convention Against Torture.

Indicate whether you are filing this application more than one year after your last arrival in the United States. Select 'Yes' if this applies.

If you are filing this application more than one year after your last arrival in the United States, explain why you did not file within the first year. Be prepared to explain this at your interview or hearing.

Indicate whether you are filing this asylum application more than one year after your last arrival in the United States by selecting 'No'.

Select 'Yes' if your spouse, parent, or child/children assisted you in completing this application. If yes, provide their names and relationships.

Enter the name of the first person who assisted you in completing this application, if applicable.

Enter the relationship of the first person who assisted you in completing this application, if applicable.

Enter the name of the second child who assisted you in completing this application, if applicable.

Enter the relationship of the second child who assisted you in completing this application, if applicable.

Select 'Yes' if someone other than your spouse, parent, or child/children prepared this application. If 'Yes', complete Part E.

Indicate if you or your family members have ever belonged to or been associated with any organizations or groups in your home country, such as political parties, student groups, labor unions, religious organizations, military or paramilitary groups, civil patrols, guerrilla organizations, ethnic groups, human rights groups, or the press or media, by selecting 'No'.

Check this box if you are seeking asylum or withholding of removal based on your religion.

Check this box if you are seeking asylum or withholding of removal based on your nationality.

Check this box if you are seeking asylum or withholding of removal based on your political opinion.

Check this box if you are seeking asylum or withholding of removal based on your membership in a particular social group.

Indicate that you affirm the truthfulness of the contents of your application and attached documents during your asylum interview by selecting 'All True'.

Indicate that not all contents of your application and attached documents are true during your asylum interview by selecting 'Not All True'.

During the asylum interview, enter the first correction number if any corrections were made to the form at your request.

During the asylum interview, enter the last correction number if any corrections were made to the form at your request.

Enter the date the form was signed and sworn to before the asylum officer during the interview. Use the format MM/DD/YYYY.

This field is for the signature of the asylum officer. The signature must be handwritten and cannot be typewritten or electronic.

Enter the attorney or state bar number of the attorney or accredited representative, if applicable.

Enter the U.S. Citizenship and Immigration Services (USCIS) Online Account Number of the attorney or accredited representative, if applicable. This number should be up to 12 characters long.

Enter the number and street of your last address before coming to the United States. If this is not the country where you fear persecution, also list the last address in the country where you fear persecution. Use additional sheets if necessary.

Enter additional details for the number and street of your last address before coming to the United States. If this is not the country where you fear persecution, also list the last address in the country where you fear persecution. Use additional sheets if necessary.

Enter the city or town of your last address before coming to the United States. If this is not the country where you fear persecution, also list the last address in the country where you fear persecution. Use additional sheets if necessary.

Indicate whether you, your spouse, or your children have ever participated in causing harm or suffering to any person because of their race, religion, nationality, membership in a particular social group, or political opinion. Select 'No' if this does not apply.

This field contains a PDF417 barcode for internal processing and tracking of the form. No input is required from the applicant.

This field contains a PDF417 barcode related to the form. No input is required from the user.

This field contains a PDF417 barcode related to the form. It is automatically generated and should not be altered.

Enter the complete last name of your first child.

Enter the city and country where your first child was born.

Enter the first name of your first child.

Enter the middle name of your first child.

Enter the date of birth of your first child in the format MM/DD/YYYY.

Enter the nationality (citizenship) of your first child.

Enter the race, ethnic, or tribal group of your first child.

Enter the current immigration status of your second child in the United States.

Enter the expiration date of your second child's authorized stay in the United States, if applicable, using the format MM/DD/YYYY.

Enter the place where your second child last entered the United States, if they are currently in the U.S.

Enter the date when your second child last entered the United States, using the format MM/DD/YYYY, if they are currently in the U.S.

Enter the I-94 number of your second child, if available, which is a record of their arrival/departure in the U.S.

Enter the status of your second child when they were last admitted to the United States, such as the type of visa they held, if any.

Enter the place of last entry into the U.S. for your additional child, if they are currently in the U.S.

Enter the date of last entry into the U.S. for your additional child, using the format MM/DD/YYYY, if they are currently in the U.S.

Enter the I-94 number for your additional child, if available. This number is typically up to 11 digits long.

Enter the status of your additional child when they were last admitted to the U.S., such as the visa type, if applicable.

Enter the current immigration status of your additional child, if they are in the U.S.

Enter the expiration date of your additional child's authorized stay in the U.S., if applicable, using the format MM/DD/YYYY.

Enter the Alien Registration Number (A-number) for Child 2, if available. This number is typically 9 digits long.

Enter the Passport or Identification Card Number for Child 2, if available.

Enter the U.S. Social Security Number for Child 2, if available. This number is typically 9 digits long.

Enter the Alien Registration Number (A-Number) for your additional child, if available. This number is typically up to 9 digits long.

Enter the passport or identification card number for your additional child, if available.

Select this checkbox if your first child is male.

Select this checkbox if your first child is female.

Select this checkbox if you do not have any children. You can then skip to Part A.3, Information about your background.

Enter the nationality or citizenship of your second child.

Indicate whether Child 2, if present in the U.S., should be included in this asylum application by selecting 'Yes'.

Indicate whether Child 2, if present in the U.S., should be included in this asylum application by selecting 'No'.

Enter the city and country where your third child was born.

Enter the first name of your third child.

Enter the middle name of your third child.

Enter the date of birth of your third child in the format MM/DD/YYYY.

Enter the nationality or citizenship of your third child.

Enter the race, ethnic, or tribal group of your third child.

Enter the current immigration status of your third child if they are in the U.S. This could be a visa type or other legal status.

Enter the expiration date of your third child's authorized stay in the U.S., if applicable, in the format MM/DD/YYYY.

Enter the Alien Registration Number (A-number) for your third child, if they have one. This number is typically 9 digits long.

Enter the passport or identification card number for your third child, if they have one.

Enter the marital status of your third child. Options include Married, Single, Divorced, or Widowed.

Enter the U.S. Social Security Number for your third child, if they have one. This number is typically 9 digits long.

Select this checkbox if your third child is male.

Select this checkbox if your third child is female.

Select this checkbox if your third child is currently in Immigration Court proceedings in the U.S.

Select this checkbox if your third child is not currently in Immigration Court proceedings in the U.S.

Indicate the gender of Child 4 by checking this box if the child is male.

Indicate the gender of Child 4 by checking this box if the child is female.

Enter the race, ethnic, or tribal group of your additional child.

Enter the U.S. Social Security Number of your additional child, if they have one. This number should be exactly 9 digits long.

Select this checkbox if your additional child is male.

Select this checkbox if your additional child is female.

Enter the current immigration status of your additional child 2 if they are currently in the U.S.

Provide the expiration date of the authorized stay for your additional child 1 in the U.S., formatted as MM/DD/YYYY.

Enter the Alien Registration Number (A-Number) for your additional child 2, if they have one. This number is typically 9 digits long.

Provide the passport or identification card number for your additional child 2, if available.

Indicate the marital status of your additional child 2. Options include Married, Single, Divorced, or Widowed.

Enter the U.S. Social Security Number for your additional child 2, if they have one. This number is typically 9 digits long.

Select this checkbox if your additional child 2 is male.

Select this checkbox if your additional child 2 is female.

Select 'Yes' if your additional child 2 is currently in immigration court proceedings in the U.S.

Select 'No' if your additional child 1 is not currently in immigration court proceedings in the U.S.

Select 'Yes' if your second child is currently in Immigration Court proceedings.

Select 'No' if your second child is not currently in Immigration Court proceedings.

If your first child is not in the U.S., enter their current location here.

Select this checkbox if your first child is currently in the U.S. and complete Blocks 14 to 21.

Select this checkbox if your first child is not in the U.S. and specify their location.

If Child 2 is not in the U.S., enter their current location.

If Child 4 is not in the U.S., specify their current location in this text field.

Check this box if Child 4 is currently in the U.S. and complete Blocks 14 to 21.

Check this box if Child 4 is not in the U.S. and specify their location.

Check this box if Child 1 is currently in the U.S. and complete Blocks 14 to 21.

If your additional child is not in the U.S., specify their current location.

Select 'Yes' if your additional child is currently in the U.S. and complete blocks 14 to 21.

Select 'No' if your additional child is not in the U.S. and specify their location.

Enter the marital status of Child 2. Options include Married, Single, Divorced, or Widowed.

Select 'Male' if Child 2's gender is male.

Select 'Female' if Child 2's gender is female.

Enter the complete last name of Child 3.

Enter the marital status of your additional child, choosing from Married, Single, Divorced, or Widowed.

If your third child is in the U.S., enter the place of their last entry into the U.S.

If your third child is in the U.S., enter the date of their last entry into the U.S. in the format MM/DD/YYYY.

If your third child is in the U.S., enter their I-94 number, if available. The I-94 number is a unique 11-digit number.

If your third child is in the U.S., enter their status when last admitted, such as the visa type, if applicable.

Enter your child's current immigration status in the United States.

Enter the expiration date of your child's authorized stay in the United States in the format MM/DD/YYYY.

Enter your child's Alien Registration Number (A-Number) if they have one. This number is typically 9 digits long.

Enter your child's passport or identification card number if they have one.

Enter your child's U.S. Social Security Number if they have one. This number is typically 9 digits long.

Enter the Alien Registration Number (A-number) for Child 4, if available. This number is typically a 9-digit number.

Enter the passport or identification card number for Child 4, if available.

Enter the U.S. Social Security Number for Child 4, if available. This number is typically a 9-digit number.

Enter your child's marital status. Options include Married, Single, Divorced, or Widowed.

Enter the marital status of Child 4. Options include Married, Single, Divorced, or Widowed.

Enter the place where your child last entered the United States. This could be a city or port of entry.

Enter the date when your child last entered the United States in the format MM/DD/YYYY.

Enter your child's I-94 Number if they have one. This number is typically 11 digits long.

Enter the status or visa type your child had when they were last admitted to the United States.

Enter the date when Child 4 last entered the United States, using the format MM/DD/YYYY.

Enter the I-94 Number for Child 4, if available. This number is typically found on the I-94 Arrival/Departure Record.

Enter the status or visa type under which Child 4 was last admitted to the United States, if applicable.

Enter the current immigration status of Child 4 in the United States.

Enter the expiration date of Child 4's authorized stay in the United States, if applicable, using the format MM/DD/YYYY.

Select this checkbox if you have children.

Enter the total number of children you have. If you have more than four children, use Form I-589 Supplement A or attach additional sheets of paper and documentation.

Indicate whether Child 3, if currently in the U.S., should be included in this asylum application by selecting 'Yes'.

Indicate whether Child 3, if currently in the U.S., should be included in this asylum application by selecting 'No'.

If Child 3 is not in the U.S., enter their current location.

Enter the complete last name of Child 4.

Enter the city and country where Child 4 was born.

Enter the first name of Child 4.

Enter the middle name of Child 4.

Enter the date of birth of Child 4 in the format MM/DD/YYYY.

Enter the nationality or citizenship of Child 4.

Enter the race, ethnic, or tribal group of Child 4.

If Child 4 is in the U.S., enter the place of their last entry into the U.S.

Enter the complete last name of your additional child 2, regardless of their age or marital status.

Enter the city and country where your additional child 2 was born.

Enter the first name of your additional child 2, regardless of their age or marital status.

Enter the middle name of your additional child 2, regardless of their age or marital status.

Enter the date of birth of your additional child 2 in the format MM/DD/YYYY.

Enter the nationality (citizenship) of your additional child 2.

Enter the race, ethnic, or tribal group of your additional child 2.

Indicate whether the additional child 2, if present in the U.S., should be included in this asylum application by selecting 'Yes'.

Indicate whether the additional child 2, if present in the U.S., should be included in this asylum application by selecting 'No'.

If the additional child 2 is not in the U.S., specify their current location.

Select 'Yes' if the additional child 2 is currently in the U.S. and complete blocks 14 to 21.

Select 'No' if the additional child 2 is not currently in the U.S. and specify their location.

If your additional child 1 is in the U.S., enter the place of their last entry into the U.S.

If your additional child 2 is in the U.S., enter the date of their last entry into the U.S. in the format MM/DD/YYYY.

If your additional child 2 is in the U.S., enter their I-94 number, if any. The I-94 number is a unique 11-digit number.

If your additional child 2 is in the U.S., enter their status when last admitted, such as the visa type, if any.

Enter the 3-digit area code of your telephone number for your current residence in the United States.

Enter your 7-digit telephone number for your current residence in the U.S.

Enter the 3-digit area code of your U.S. mailing address telephone number, if different from the address in Item Number 7.

Enter the 7-digit telephone number of your U.S. mailing address, excluding the area code, if different from the address in Item Number 7.

Enter the name of the person 'In Care Of' for your U.S. mailing address, if applicable.

Select 'Yes' if you or any family member included in the application has ever committed a crime or been involved in legal proceedings related to criminal activities in the United States.

Provide detailed information about any crimes committed by you or your family members included in the application, including circumstances, dates, sentences, and any related documents.

Indicate whether you or any family member included in the application has never committed a crime or been involved in legal proceedings related to criminal activities in the United States by selecting 'No'.

Enter the number and street of your present address. This is the first line of your current address.

Enter the number and street of your present address. This is the second line of your current address if needed.

Enter the city or town of your present address.

Enter the city or town of your present address.

Indicate if the form was prepared by someone other than the applicant, spouse, parent, or child. Check this box if an attorney or accredited representative prepared the form.

Enter the name of the most recent school you attended. Use additional sheets if necessary.

Enter the name of the second most recent school you attended. Use additional sheets if necessary.

Specify the type of the most recent school you attended (e.g., high school, university).

Specify the type of the second most recent school you attended (e.g., high school, university).

Enter the address of the most recent school you attended.

Enter the address of the second most recent school you attended.

Enter the start date of your most recent educational experience in the format MM/YY.

Enter the start date of your educational experience in the format MM/YY.

Enter the end date of your most recent educational experience in the format MM/YY.

Enter the end date of your educational experience in the format MM/YY.

Enter the name of the school you attended.

Enter the type of school you attended (e.g., high school, university).

Enter the location or address of the school you attended.

Enter the start date of your educational experience in the format MM/YY.

Enter the date you stopped attending the most recent educational institution. Use a 2-digit month and 2-digit year format (e.g., 06/21 for June 2021).

Enter the name of the educational institution you most recently attended. This is the fourth entry in your list of schools.

Specify the type of school you attended, such as high school, college, or university.

Provide the address of the educational institution you attended, including street, city, and country.

Enter the date you started attending the most recent educational institution. Use a 2-digit month and 2-digit year format (e.g., 09/19 for September 2019).

Enter the date you stopped attending the most recent educational institution. Use a 2-digit month and 2-digit year format (e.g., 06/21 for June 2021).

Enter the name and address of your current or most recent employer. This is the first entry in your list of employers from the past 5 years.

Enter the name and address of your second most recent employer. This is the second entry in your list of employers from the past 5 years.

Enter your current or most recent occupation. This should be the job title or role you held during your employment.

Enter your current or most recent occupation. This should be the job title or role you held during your employment.

Enter the start date of your employment in the format MM/YY. This is the date when you began working at this job.

Enter the start date of your employment in the format MM/YY. This is the date when you began working at this job.

Enter the end date of your employment in the format MM/YY. This is the date when you stopped working at this job.

Enter the end date of your employment in the format MM/YY. This is the date when you stopped working at this job.

Enter the name and address of your employer. This should include the company or organization name and its full address.

Enter your current or most recent occupation. This should be the job title or role you held during your employment.

Enter the start date of your employment in the format MM/YY for the past 5 years, starting with your current job.

Enter the end date of your employment in the format MM/YY for the past 5 years, starting with your current job.

Enter the date when your most recent entry status expires, formatted as MM/DD/YYYY.

Enter the complete last name of your second child. Ensure the name is spelled correctly as it appears on official documents.

Enter the city and country where your second child was born. Use the official names as they appear on birth certificates or other legal documents.

Enter the first name of your second child. Ensure the name is spelled correctly as it appears on official documents.

Enter the middle name of your second child, if applicable. Ensure the name is spelled correctly as it appears on official documents.

Enter the date of birth of your second child in the format MM/DD/YYYY. Ensure the date matches official documents like birth certificates.

Indicate whether Child 1 is currently in the United States by selecting 'No'. If 'No', specify the child's current location.

Indicate whether Child 1 is currently in the United States by selecting 'Yes'. If 'Yes', complete Blocks 14 to 21 with additional information.

Indicate whether Child 1 is currently in the United States by selecting 'No'. If 'No', specify the child's current location.

Enter the race, ethnic, or tribal group of Child 2.

Enter the full name of your mother. Indicate if she is deceased by checking the appropriate box.

Enter the full name of your father. Indicate if he is deceased by checking the appropriate box.

Enter the full name of your first sibling. Indicate if they are deceased by checking the appropriate box.

Enter the city/town and country where your mother was born.

Enter the city/town and country where your father was born.

Enter the city/town and country where your first sibling was born.

Check this box if your mother is deceased.

Check this box if your father is deceased.

Check this box if your first sibling is deceased.

Enter the full name of your second sibling.

Enter the city/town and country of birth for your second sibling.

Check this box if your second sibling is deceased.

Enter the full name of your third sibling.

Enter the city/town and country of birth for your third sibling.

Check this box if Sibling 3 is deceased.

Enter the full name of Sibling 4.

Enter the city/town and country of birth for Sibling 4.

Check this box if Sibling 4 is deceased.

Enter the current location of your mother.

Enter the current location of your father.

Enter the current location of Sibling 1.

Enter the current location of Sibling 2.

Enter the current location of your third sibling. If the sibling is deceased, check the appropriate box.

Enter the current location of your fourth sibling. If the sibling is deceased, check the appropriate box.

Enter the complete last name of your additional child, regardless of their age or marital status.

Enter the city and country where your additional child was born.

Enter the first name of your additional child, regardless of their age or marital status.

Enter the middle name of your additional child, regardless of their age or marital status.

Enter the date of birth of your additional child in the format MM/DD/YYYY.

Enter the nationality (citizenship) of your additional child.

Select 'Yes' if you fear harm or mistreatment if you return to your home country.

Explain in detail the harm or mistreatment you fear if you return to your home country, who you believe would harm you, and why you believe you would be harmed.

Indicate if you are afraid of being subjected to torture in your home country or any other country to which you may be returned by selecting 'Yes'.

If you are afraid of being subjected to torture, explain why you are afraid, describe the nature of the torture you fear, who would inflict it, and why.

Indicate if you are afraid of being subjected to torture in your home country or any other country to which you may be returned by selecting 'No'.

This field contains a barcode that encodes specific information about the form and its version. It is automatically generated and does not require user input.

This field is automatically filled with a barcode related to the form and should not be edited.

This field contains a PDF417 barcode related to the form. No input is required.

This field contains a barcode related to the form. No input is required from the user.

This field contains a barcode related to the form. No input is required from the user.

This field contains a barcode related to the form I-589, which includes the form version and page number.

This field contains a barcode related to the form. It is automatically generated and does not require user input.

This field contains a barcode related to the form. No input is required.

This field contains a PDF417 barcode related to the form I-589. It is not editable.

Enter the date in the format MM/DD/YYYY.

Select this checkbox if you have never been in Immigration Court proceedings.

Select this checkbox if you are not currently in Immigration Court proceedings, but have been in the past.

Select this checkbox if you are currently in Immigration Court proceedings.

Indicate whether you, your spouse, your children, or other family members have ever applied for or received any lawful status in any country other than the one from which you are now claiming asylum. Select 'No' if this does not apply.

Select this checkbox if your first child, who is in the U.S., is currently in Immigration Court proceedings.

Select this checkbox if your first child, who is in the U.S., is not in Immigration Court proceedings.

Check this box if Child 4 is currently in Immigration Court proceedings in the U.S.

Check this box if Child 4 is not in Immigration Court proceedings in the U.S.

Select 'Yes' if your additional child is currently in Immigration Court Proceedings in the U.S.

Select 'No' if your additional child is not in Immigration Court Proceedings in the U.S.

If you answered 'Yes' to the previous question, describe in detail each incident of harm or suffering caused and the involvement of you, your spouse, or children.

Enter your native language, including dialect if applicable.

Select 'Yes' if you are fluent in English.

Select 'No' if you are not fluent in English.

Select 'Yes' if you have been provided with a list of persons who may assist you with your asylum claim at little or no cost.

Indicate whether you or your family members have ever been accused, charged, arrested, detained, interrogated, convicted, sentenced, or imprisoned in any country other than the United States by selecting 'Yes'.

If you answered 'Yes' to the previous question, explain the circumstances and reasons for the legal actions taken against you or your family members in any country other than the United States.

Indicate if you or your family members have ever been accused, charged, arrested, detained, interrogated, convicted, sentenced, or imprisoned in any country other than the United States, including for immigration law violations, by selecting 'No'.

Indicate whether you or your family members have ever applied for or received lawful status in any country other than the one from which you are claiming asylum.

Enter the apartment number for your mailing address in the U.S., if different from your residence.

Enter the street number and name for your mailing address in the U.S., if different from your residence.

Enter the 5-digit ZIP code for your mailing address in the U.S., if different from your residence.

Enter the city for your mailing address in the U.S., if different from your residence.

Enter the state for your mailing address in the U.S., if different from your residence.

Select this checkbox if you are not married. If selected, skip to the 'Your Children' section.

Enter your present nationality or citizenship.

This field is for official use by the Executive Office for Immigration Review (EOIR) only. No input is required from the applicant.

This field is for official use by the U.S. Citizenship and Immigration Services (USCIS) only. An Asylum Officer will enter their ID number here. No input is required from the applicant.

This field is for official use by the USCIS only. An officer will enter the approval date of the asylum application in the format MM/DD/YYYY. No input is required from the applicant.

This field is for official use by the USCIS only. An officer will enter the denial date of the asylum application in the format MM/DD/YYYY. No input is required from the applicant.

This field is for official use by the USCIS only. An officer will enter the referral date of the asylum application in the format MM/DD/YYYY. No input is required from the applicant.

This field is for official use by the USCIS only. An officer will enter the interview date for the asylum application in the format MM/DD/YYYY. No input is required from the applicant.

Indicate whether you or your family members have ever belonged to or been associated with any organizations or groups in your home country by selecting 'Yes'.

If you answered 'Yes' to the previous question, describe for each person the level of participation, any leadership or other positions held, and the length of time involved in each organization or activity.

Indicate whether you or your family members continue to participate in any organizations or groups mentioned in the previous question by selecting 'Yes'.

If you or your family members continue to participate in any organizations or groups, describe the current level of participation, any leadership or other positions held, and the duration of involvement for each person.

Indicate whether you or your family members continue to participate in any organizations or groups mentioned in the previous question by selecting 'No'.

Enter the name of the country that issued your most recent passport or travel document.

Enter the number of your most recent passport.

Enter the expiration date of your passport or travel document, formatted as MM/DD/YYYY.

Provide detailed information about any past applications for refugee status, asylum, or withholding of removal by you or your family members. Include the decision, any status received, and changes in conditions or personal circumstances since any denial.

Indicate whether you or your family members have never applied to the U.S. Government for refugee status, asylum, or withholding of removal.

Indicate whether you, your spouse, or children have ever participated in causing harm or suffering to others based on race, religion, nationality, social group, or political opinion.

Select 'Yes' if you, your family, or close friends or colleagues have ever experienced harm, mistreatment, or threats in the past.

Provide a detailed explanation of any harm, mistreatment, or threats you, your family, or close friends or colleagues have experienced. Include what happened, when it occurred, who caused it, and why you believe it happened.

Enter your Alien Registration Number (A-Number) if you have one. This is a unique 9-digit number assigned to non-citizens by the U.S. Citizenship and Immigration Services.

Enter your U.S. Social Security Number if you have one. This is a 9-digit number issued to U.S. citizens, permanent residents, and temporary (working) residents.

Enter your complete last name as it appears on official documents.

Enter any other names you have used, including maiden names and aliases.

Enter your date of birth in the format MM/DD/YYYY, where MM is the 2-digit month, DD is the 2-digit day, and YYYY is the 4-digit year.

Enter your first name as it appears on official documents.

Enter your middle name as it appears on official documents.

Select this checkbox if your gender is male.

Select this checkbox if your gender is female.

Select this checkbox if your current marital status is 'Single'.

Select this checkbox if your current marital status is 'Married'.

Select this checkbox if your current marital status is 'Divorced'.

Select this checkbox if your current marital status is 'Widowed'.

Enter the city and country where you were born.

Enter your nationality at the time of your birth.

Enter your race, ethnic, or tribal group.

Enter your religion.

Enter your current I-94 Number, if you have one. The I-94 is a form used by U.S. Customs and Border Protection to track the arrival and departure of foreign nationals.

List all languages you can speak fluently.

Enter your USCIS Online Account Number if you have one. This number can be up to 12 characters long.

Print your complete name as it appears on official documents.

Write your name in your native alphabet, if applicable.

Enter your Alien Registration Number (A-Number) if you have one. This is a unique identifier assigned to non-citizens by the U.S. government.

Enter the full name of the applicant.

The preparer must sign here to declare that they prepared the application at the request of the applicant and that the information is accurate. This form cannot be signed electronically.

Print the complete name of the person who prepared the form, if other than the applicant, spouse, parent, or child.

Enter the apartment number of the person who prepared the form, if it was not prepared by the applicant, their spouse, parent, or child.

Enter the city of the person who prepared the form, if it was not prepared by the applicant, their spouse, parent, or child.

Enter the state of the person who prepared the form, if it was not prepared by the applicant, their spouse, parent, or child.

Enter the zip code of the person who prepared the form, if it was not prepared by the applicant, their spouse, parent, or child. The zip code should be 5 digits long.

Enter the street number and name of the person who prepared the form, if it was not prepared by the applicant, their spouse, parent, or child.

Enter the 7-digit daytime telephone number of the person who prepared the form, if it was not prepared by the applicant, their spouse, parent, or child.

Enter the 3-digit area code for the daytime telephone number of the person who prepared the form, if it was not prepared by the applicant, their spouse, parent, or child.

Indicate if you, your spouse, your children, your parents, or your siblings have ever applied to the U.S. Government for refugee status, asylum, or withholding of removal by selecting 'Yes'.

Enter the first correction number that you or someone at your request made to the application during the removal hearing.

Enter the last correction number that you or someone at your request made to the application during the removal hearing.

Enter the date when the application was signed and sworn before the immigration judge, using the format MM/DD/YYYY.

This field is for the signature of the immigration judge. Note that it cannot be signed electronically or typewritten.

Write your name in your native alphabet as part of the removal hearing documentation.

This field is for your signature as the applicant. Note that it cannot be signed electronically or typewritten.

Indicate that you affirm the truthfulness of the contents of your application and attached documents during your removal hearing by selecting 'All True'.

Indicate if the statement that the contents of the application are not all true to the best of your knowledge is applicable during the removal hearing.

Enter the department, province, or state of your current or past residence within the last 5 years, starting with your present address.

Enter the department, province, or state of your current or past residence within the last 5 years, starting with your present address.

Enter the country of your current or past residence within the last 5 years, starting with your present address.

Enter the country of your current or past residence within the last 5 years, starting with your present address.

Enter the start date of your residence in the format MM/YY, beginning with your current address.

Enter the start date of your residence in the format MM/YY, beginning with your current address.

Enter the end date of your residence in the format MM/YY, beginning with your current address.

Enter the end date of your residence in the format MM/YY, beginning with your current address.

Enter the street number and name of your current or past residence. This is the third address in the list of your residences over the past 5 years.

Enter the city or town of your current or past residence. This is the third address in the list of your residences over the past 5 years.

Enter the department, province, or state of your current or past residence. This is the third address in the list of your residences over the past 5 years.

Enter the country of your current or past residence. This is the third address in the list of your residences over the past 5 years.

Enter the start date (month and year) for the period you lived at this residence. Use a 2-digit format for both month and year.

Enter the end date (month and year) for the period you lived at this residence. Use a 2-digit format for both month and year.

Enter the street number and name of your current or past residence. This is the fourth address in the list of your residences over the past 5 years.

Enter the city or town of your current or past residence. This is the fourth address in the list of your residences over the past 5 years.

Enter the department, province, or state of your current or past residence from the last 5 years, starting with your present address.

Enter the country of your current or past residence from the last 5 years, starting with your present address.

Enter the start date (month and year) of your residence at a specific address from the last 5 years, using a 2-digit month and 2-digit year format.

Enter the end date (month and year) of your residence at a specific address from the last 5 years, using a 2-digit month and 2-digit year format.

Enter the number and street of your current or past residence from the last 5 years, starting with your present address.

Enter the city or town of your current or past residence from the last 5 years, starting with your present address.

Enter the department, province, or state of your current or past residence from the last 5 years, starting with your present address.

Enter the country of your current or past residence from the last 5 years, starting with your present address.

Enter the start date of your residence in the format MM/YY for the past 5 years, starting with your current address.

Enter the end date of your residence in the format MM/YY for the past 5 years, starting with your current address.

Enter the street number and name of your current residence in the United States.

Enter the city of your current residence in the United States.

Enter the apartment number of your current residence in the U.S.

Enter the state where your current residence in the U.S. is located.

Enter the 5-digit ZIP code for your current residence in the U.S.

Provide the applicant's handwritten signature. Electronic signatures or typewritten names are not accepted.

Select 'Yes' if your spouse is currently in Immigration Court Proceedings.

Select 'No' if your spouse is not currently in Immigration Court Proceedings.

Enter the Alien Registration Number (A-Number) for your spouse, if they have one. This number can be up to 9 digits long.

Enter the complete last name of your spouse.

Enter the date of your marriage in the format MM/DD/YYYY.

Enter the nationality or citizenship of your spouse.

If your spouse is not in the U.S., enter their current location.

Enter the place where your spouse last entered the U.S.

Enter the current immigration status of your spouse.

Enter the passport or identification card number of your spouse, if they have one.

Enter the date of birth of your spouse in the format MM/DD/YYYY.

Enter your spouse's U.S. Social Security Number, if they have one. This should be a 9-digit number.

Enter the first name of your spouse.

Enter the middle name of your spouse, if applicable.

Enter the maiden name of your spouse, if applicable.

Enter the place where you and your spouse were married.

Enter the city and country where your spouse was born.

Enter the race, ethnic, or tribal group of your spouse.

Select this checkbox if your spouse's gender is male.

Select this checkbox if your spouse's gender is female.

Select this checkbox if your spouse is not currently in the U.S. and specify their location.

Enter the date when your spouse last entered the United States. Use the format MM/DD/YYYY.

Enter your spouse's I-94 number, if available. This number is up to 11 digits long.

Enter the status or visa type your spouse had when they were last admitted to the United States.

Enter the expiration date of your spouse's authorized stay in the United States, if applicable. Use the format MM/DD/YYYY.

Enter the date of your spouse's previous arrival in the United States, if they have been here before. Use the format MM/DD/YYYY.

Indicate whether your spouse is currently in the United States by selecting 'Yes'. If 'Yes', complete Blocks 16 to 24.

If you answered 'Yes' to questions 2.A or 2.B, provide details for each person, including the countries visited, length of stay, status, reasons for leaving, and whether they applied for refugee status or asylum.

Enter the number of your most recent travel document, if applicable.

Enter the date when you last left your country. Use the format MM/DD/YYYY.

Indicate whether you, your spouse, or children traveled through or resided in another country before entering the United States after leaving the country from which you are claiming asylum.

Indicate whether you, your spouse, or your children traveled through or resided in any other country before entering the United States after leaving the country from which you are claiming asylum. Select 'No' if this does not apply.

Indicate whether you returned to the country where you were harmed or fear harm after leaving it. Select 'Yes' if this applies.

If you returned to the country where you were harmed or fear harm, describe in detail the circumstances of your visit(s), including the date(s), purpose(s), and duration of your stay.

Indicate whether you returned to the country where you were harmed or fear harm after leaving it. Select 'No' if this does not apply.

Enter the date of your most recent entry into the U.S. Use the format MM/DD/YYYY.

Enter the place of your most recent entry into the U.S. This could be the name of the airport, seaport, or border crossing.

Enter your status at the time of your most recent entry into the U.S. This could be a visa type or other status.

Enter the date of your second most recent entry into the U.S. Use the format MM/DD/YYYY.

Enter the place of your second most recent entry into the U.S. This could be the name of the airport, seaport, or border crossing.

Enter your status at the time of your second most recent entry into the U.S. This could be a visa type or other status.

Enter the date of your third most recent entry into the U.S. Use the format MM/DD/YYYY.

Enter the place of your third most recent entry into the U.S. This could be the name of the airport, seaport, or border crossing.

Enter your status at the time of your third most recent entry into the U.S. This could be a visa type or other status.