Form N-300, Application to File Declaration of Intention Instructions
This form contains 152 fields organized into 21 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Absence Information | ||
| Part 1. Information About You. 9. Since you were admitted to the United States as a lawful permanent resident, have you been absent for a period of six months or longer? Select Yes. If you answered "Yes" to Item Number 9., provide departure / arrival dates of all absences in the space provided in Part 5. Additional Information | CheckBox |
Select 'Yes' if you have been absent from the United States for a period of six months or longer since you were admitted as a lawful permanent resident. If 'Yes', provide the departure and arrival dates of all absences in Part 5. Additional Information.
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| Part 1. Information About You. 9. Since you were admitted to the United States as a lawful permanent resident, have you been absent for a period of six months or longer? Select No | CheckBox |
Select 'No' if you have not been absent from the United States for a period of six months or longer since you were admitted as a lawful permanent resident.
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| Additional Information | ||
| Part 5. Additional Information. 5. D. Enter Additional Information | Text |
Provide any additional information that is relevant to your application.
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| Part 5. Additional Information. 3. A. Enter Page Number | Text |
Enter the page number of the form where additional information is being referenced.
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| Part 5. Additional Information. 3. B. Enter Part Number | Text |
Enter the part number of the form where additional information is being referenced.
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| Part 5. Additional Information. 3. C. Enter Item Number | Text |
Enter the item number of the form where additional information is being referenced.
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| Part 5. Additional Information. 3. D. Enter Additional Information | Text |
Provide any additional information that is relevant to your application.
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| Part 5. Additional Information. 6. A. Enter Page Number | Text |
Enter the page number of the form where additional information is being referenced.
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| Part 5. Additional Information. 6. B. Enter Part Number | Text |
Enter the part number of the form where additional information is being referenced.
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| Part 5. Additional Information. 6. C. Enter Item Number | Text |
Enter the item number related to the additional information you are providing.
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| Part 5. Additional Information. 6. D. Enter Additional Information | Text |
Provide any additional information related to the item number specified.
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| Part 5. Additional Information. 5. C. Enter Item Number | Text |
Enter the item number related to the additional information you are providing.
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| Part 5. Additional Information. 5. B. Enter Part Number | Text |
Enter the part number related to the additional information you are providing.
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| Part 5. Additional Information. 5. A. Enter Page Number | Text |
Enter the page number related to the additional information you are providing.
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| Part 5. Additional Information. 4. A. Enter Page Number | Text |
Enter the page number related to the additional information you are providing.
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| Part 5. Additional Information. 4. B. Enter Part Number | Text |
Enter the part number related to the additional information you are providing.
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| Part 5. Additional Information. 4. C. Enter Item Number | Text |
Enter the item number related to the additional information you are providing.
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| Part 5. Additional Information. 4. D. Enter Additional Information | Text |
Provide any additional information related to the item number specified.
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| Part 5. Additional Information. 2. A. Number, if any. This field is pre-populated from Page 1 | Text |
This field is pre-populated from Page 1 and contains your Alien Registration Number (A-Number), if any.
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| Applicant's Contact Information | ||
| Part 2. Applicant's Statement, Contact Information, Declaration, Certification, and Signature. Applicant's Contact Information. 5. Enter Applicant's Email Address, if any | Text |
Enter your email address, if you have one.
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| Part 2. Applicant's Statement, Contact Information, Declaration, Certification, and Signature. Applicant's Contact Information. 3. Enter Applicant's Daytime Telephone Number. Enter 10 digit number | Text |
Enter your daytime telephone number. This should be a 10-digit number.
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| Part 2. Applicant's Statement, Contact Information, Declaration, Certification, and Signature. Applicant's Contact Information. 4. Enter Applicant's Mobile Telephone Number, if any. Enter 10 digit number | Text |
Enter your mobile telephone number. Ensure it is a 10-digit number.
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| Applicant's Information | ||
| Part 3. Interpreter's Contact Information, Certification, and Signature. Enter Your 9 Digit A. Number | Text |
Enter your 9-digit Alien Registration Number (A-Number).
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| Applicant's Statement | ||
| Part 2. Applicant's Statement, Contact Information, Declaration, Certification, and Signature. NOTE: Read the Penalties section of the Form N - 300 Instructions before completing this part. You must file Form N - 300 while in the United States. Applicant'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. Applicant's Statement Regarding the Interpreter. A. Select I can read and understand English, and I have read and understand each and every question and instruction on this form, as well as my answer to each question | CheckBox |
Select this checkbox if you can read and understand English, and you have read and understand each and every question and instruction on this form, as well as your answer to each question.
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| Part 2. Applicant's Statement, Contact Information, Declaration, Certification, and Signature. NOTE: Read the Penalties section of the Form N - 300 Instructions before completing this part. You must file Form N - 300 while in the United States. Applicant'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. Applicant's Statement Regarding the Interpreter. B. Select The interpreter named in Part 3. read to me every question and instruction on this application and my answer to every question in a language in which I am fluent and I understood everything | CheckBox |
Select this checkbox if the interpreter named in Part 3 read to you every question and instruction on this application and your answer to every question in a language in which you are fluent, and you understood everything.
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| Part 2. Applicant's Statement, Contact Information, Declaration, Certification, and Signature. Applicant's Statement. 1. B. Enter Language | Text |
Enter the language in which the interpreter read the questions and instructions to you.
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| Part 2. Applicant's Statement, Contact Information, Declaration, Certification, and Signature. NOTE: Read the Penalties section of the Form N - 300 Instructions before completing this part. You must file Form N - 300 while in the United States. Applicant'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. Applicant's Statement Regarding the Preparer. Select At my request, the preparer named in Part 4. prepared this application for me based only upon information I provided or authorized | CheckBox |
Select this checkbox if, at your request, the preparer named in Part 4 prepared this application for you based only upon information you provided or authorized.
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| Part 2. Applicant's Statement, Contact Information, Declaration, Certification, and Signature. Applicant's Statement. 2. Enter Name of Preparer | Text |
Enter the name of the preparer who prepared this application for you.
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| Part 2. Applicant's Statement, Contact Information, Declaration, Certification, and Signature. Applicant's Signature. 6. Applicant's Signature. This form can not be signed electronically. The name of the applicant can not be typewritten into this space. NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the Instructions, U S C I S may deny your application | Text |
Provide your handwritten signature. Note that this form cannot be signed electronically and the name cannot be typewritten.
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| Part 2. Applicant's Statement, Contact Information, Declaration, Certification, and Signature. Applicant's Signature. 6. Enter Date of Signature. Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date you signed the form in the format MM/DD/YYYY.
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| Part 2. Applicant's Statement, Contact Information, Declaration, Certification, and Signature. Enter Your 9 Digit A. Number | Text |
Enter your 9-digit Alien Registration Number (A-Number).
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| Part 6. Declaration of Intention. I am over 18 years of age, have been lawfully admitted to the United States as a lawful permanent resident, and am now residing in the United States based on such admission. I hereby declare my intention in good faith to become a citizen of the United States and I certify that the photographs affixed to the original and duplicate hereof are a likeness of me and were signed by me. I do swear (or affirm) that the statements I have made and the intentions I have expressed in this declaration of intention subscribed by me are true to the best of my knowledge and belief. Applicant's and U S C I S Officer's Signature. 15. Applicant's Signature (U S C I S will reject your Form N - 300 if it is not signed). This form can not be signed electronically. The name of the applicant can not be typewritten into this space | Text |
Sign this section to declare your intention to become a U.S. citizen. Note that USCIS will reject your Form N-300 if it is not signed. This form cannot be signed electronically, and the name of the applicant cannot be typewritten into this space.
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| Part 6. Declaration of Intention. Applicant's and U S C I S Officer's Signature. 15. Enter Date of Signature. Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date of your signature in the format MM/DD/YYYY.
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| Attorney/Representative Information | ||
| To be completed by an attorney or accredited representative, if any. Select this box if Form G - 28 is attached | CheckBox |
Select this box if Form G-28 (Notice of Entry of Appearance as Attorney or Accredited Representative) is attached.
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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 state bar number of your attorney, if applicable.
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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. 12 characters | Text |
Enter the USCIS Online Account Number of your attorney or accredited representative, if they have one.
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| Citizenship Details | ||
| Part 1. Information About You. 8. Enter Country of Citizenship or Nationality | Text |
Enter the country where you currently hold citizenship or nationality.
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| Part 6. Declaration of Intention. 7. Enter Country of Citizenship or Nationality | Text |
Enter the country where you currently hold citizenship or nationality.
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| Contact Information | ||
| Part 1. Information About You. 11. Physical Address (if different from the address above). Enter Street Number and Name (Do not provide a P O Box in this space unless it is your ONLY address) | Text |
Enter the street number and name of your physical address if it is different from the address provided above. Do not use a P.O. Box unless it is your only address.
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| Part 1. Information About You. 11. Physical Address (if different from the address above). Select Apartment | CheckBox |
Select this checkbox if your physical address is an apartment.
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| Part 1. Information About You. 11. Physical Address (if different from the address above). Select Suite | CheckBox |
Select this checkbox if your physical address is a suite.
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| Part 1. Information About You. 11. Physical Address (if different from the address above). Select Floor | CheckBox |
Select this checkbox if your physical address is a floor.
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| Part 1. Information About You. 11. Physical Address (if different from the address above). Enter Apartment, Suite or Floor Number | Text |
Enter the apartment, suite, or floor number of your physical address if it is different from the address provided above.
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| Part 1. Information About You. 11. Physical Address (if different from the address above). Enter City or Town | Text |
Enter the city or town of your physical address if it is different from the address provided above.
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| Part 1. Information About You. 11. Physical Address (if different from the address above). Select State from List of States | ComboBox |
Select the state of your physical address from the provided list if it is different from the address provided above.
AE
DE
FL
MI
NH
WY
NY
DC
CO
MS
IN
UT
SD
WA
WI
GU
HI
NE
OH
TN
CA
OR
VA
IL
MH
MO
NM
NV
GA
KS
RI
SC
NJ
KY
VI
LA
ME
MP
MT
PW
PR
WV
AA
FM
IA
AL
AZ
TX
VT
AR
ND
MN
AP
MD
PA
AK
AS
MA
NC
ID
CT
OK
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| Part 1. Information About You. 11. Physical Address (if different from the address above). Enter Zip Code | Text |
Enter the zip code of your physical address if it is different from the address provided above.
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| Part 6. Declaration of Intention. 10. Enter Daytime Telephone Number | Text |
Enter your daytime telephone number. This field can contain up to 18 characters.
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| Part 6. Declaration of Intention. 13. Enter Mobile Telephone Number, if any | Text |
Enter your mobile telephone number, if you have one.
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| Part 6. Declaration of Intention. 14. Enter Email Address, if any | Text |
Enter your email address, if you have one.
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| Declaration of Intention | ||
| Part 6. Declaration of Intention. Enter Your 9 Digit A. Number | Text |
Enter your 9-digit Alien Registration Number (A-Number) here.
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| Part 6. Declaration of Intention. 2. Enter U. S. Social Security Number, if any | Text |
Enter your U.S. Social Security Number, if you have one.
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| Part 6. Declaration of Intention. Enter U S C I S Online Account Number, if any | Text |
Enter your USCIS Online Account Number, if you have one.
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| Part 6. Declaration of Intention. 1. Your Current Legal Name (Do not provide a nickname). Enter Family Name (Last Name) | Text |
Enter your current legal family name (last name). Do not provide a nickname.
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| Part 6. Declaration of Intention. 1. Your Current Legal Name (Do not provide a nickname). Enter Given Name (First Name) | Text |
Enter your current legal given name (first name). Do not provide a nickname.
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| Part 6. Declaration of Intention. 1. Your Current Legal Name (Do not provide a nickname). Enter Middle Name | Text |
Enter your current legal middle name, if you have one. Do not provide a nickname.
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| Part 6. Declaration of Intention. 4. Enter Date of Birth. Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter your date of birth in the format MM/DD/YYYY.
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| Part 6. Declaration of Intention. 5. Enter Date You Became a Lawful Permanent Resident. Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date you became a lawful permanent resident in the format MM/DD/YYYY.
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| Part 6. Declaration of Intention. 12. Enter Evening Telephone Number | Text |
Enter your evening telephone number.
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| Part 6. Declaration of Intention. 11. Enter Work Telephone Number, if any | Text |
Enter your work telephone number, if you have one.
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| Part 6. Declaration of Intention. 6. Enter Country of Birth | Text |
Enter the country where you were born.
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| Interpreter Information | ||
| Part 3. Interpreter's Contact Information, Certification, and Signature. Interpreter's Certification. I certify, under penalty of perjury, that: I am fluent in English and the same language provided in Part 2., Item B., in Item Number 1.; and I have read to this applicant in the identified language every question and instruction on this application and his or her answer to every question. The applicant informed me that he or she understands every instruction, question, and answer on the application, including the Applicant's Declaration and Certification, and has verified the accuracy of every answer. Enter Other Language | Text |
Enter the language in which the interpreter is fluent and has communicated with the applicant.
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| Part 3. 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 | Text |
The interpreter must sign this section. Note that electronic signatures are not allowed, and the name cannot be typewritten.
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| Part 3. 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 | Text |
Enter the date when the interpreter signed the form in MM/DD/YYYY format.
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| Part 3. Interpreter's Contact Information, Certification, and Signature. Interpreter's Contact Information. 6. Enter Interpreter's Email Address, if any | Text |
Enter the email address of the interpreter, if available.
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| Part 3. Interpreter's Contact Information, Certification, and Signature. Interpreter's Contact Information. 4. Enter Interpreter's Daytime Telephone Number. Enter 10 digit number | Text |
Enter the daytime telephone number of the interpreter. It should be a 10-digit number.
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| Part 3. Interpreter's Contact Information, Certification, and Signature. Interpreter's Contact Information. 5. Enter Interpreter's Mobile Telephone Number, if any. Enter 10 digit number | Text |
Enter the mobile telephone number of the interpreter, if available. It should be a 10-digit number.
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| Interpreter's Contact Information | ||
| Part 3. 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 where the interpreter's mailing address is located.
AE
DE
FL
MI
NH
WY
NY
DC
CO
MS
IN
UT
SD
WA
WI
GU
HI
NE
OH
TN
CA
OR
VA
IL
MH
MO
NM
NV
GA
KS
RI
SC
NJ
KY
VI
LA
ME
MP
MT
PW
PR
WV
AA
FM
IA
AL
AZ
TX
VT
AR
ND
MN
AP
MD
PA
AK
AS
MA
NC
ID
CT
OK
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| Part 3. 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. Maximum length is 25 characters.
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| Part 3. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. Select Suite | CheckBox |
Check this box if the interpreter's mailing address includes a suite.
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| Part 3. 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.
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| Part 3. 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.
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| Part 3. 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.
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| Part 3. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. Enter Country | Text |
Enter the country of the interpreter's mailing address.
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| Part 3. 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.
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| Interpreter's Information | ||
| Part 3. Interpreter's Contact Information, Certification, and Signature. Provide the following information about the interpreter. Interpreter's Full Name. 1. Enter Interpreter's Given Name (First Name) | Text |
Enter the given name (first name) of the interpreter assisting with this form.
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| Part 3. 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 family name (last name) of the interpreter assisting with this form.
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| Part 3. Interpreter's Contact Information, Certification, and Signature. Provide the following information about the interpreter. 2. Enter Interpreter's Business or Organization Name, if any | Text |
Enter the business or organization name of the interpreter, if applicable.
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| Part 3. 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.
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| Part 3. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. Enter Province | Text |
Enter the province of the interpreter's mailing address.
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| Part 3. 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.
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| Mailing Address | ||
| Part 1. Information About You. 10. Mailing Address. Enter Street Number and Name | Text |
Enter the street number and name of your mailing address.
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| Part 1. Information About You. 10. Mailing Address. Select Apartment | CheckBox |
Select this checkbox if your mailing address includes an apartment.
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| Part 1. Information About You. 10. Mailing Address. Select Suite | CheckBox |
Select this checkbox if your mailing address includes a suite.
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| Part 1. Information About You. 10. Mailing Address. Select Floor | CheckBox |
Select this checkbox if your mailing address includes a floor.
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| Part 1. Information About You. 10. Mailing Address. Enter Apartment, Suite or Floor Number | Text |
Enter the apartment, suite, or floor number of your mailing address.
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| Part 1. Information About You. 10. Mailing Address. Enter City or Town | Text |
Enter the city or town of your mailing address.
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| Part 1. Information About You. 10. Mailing Address. Select State from List of States | ComboBox |
Select the state of your mailing address from the provided list.
AE
DE
FL
MI
NH
WY
NY
DC
CO
MS
IN
UT
SD
WA
WI
GU
HI
NE
OH
TN
CA
OR
VA
IL
MH
MO
NM
NV
GA
KS
RI
SC
NJ
KY
VI
LA
ME
MP
MT
PW
PR
WV
AA
FM
IA
AL
AZ
TX
VT
AR
ND
MN
AP
MD
PA
AK
AS
MA
NC
ID
CT
OK
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| Part 1. Information About You. 10. Mailing Address. Enter Zip Code | Text |
Enter the zip code of your mailing address.
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| Part 6. Declaration of Intention. 8. Mailing Address. Enter Street Number and Name | Text |
Enter the street number and name of your mailing address.
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| Part 6. Declaration of Intention. 8. Mailing Address. Select Apartment | CheckBox |
Select this checkbox if your mailing address includes an apartment.
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| Part 6. Declaration of Intention. 8. Mailing Address. Select Suite | CheckBox |
Select this checkbox if your mailing address includes a suite.
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| Part 6. Declaration of Intention. 8. Mailing Address. Select Floor | CheckBox |
Select this checkbox if your mailing address includes a floor number.
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| Part 6. Declaration of Intention. 8. Mailing Address. Enter Apartment, Suite or Floor Number | Text |
Enter the apartment, suite, or floor number of your mailing address.
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| Part 6. Declaration of Intention. 8. Mailing Address. Enter City or Town | Text |
Enter the city or town of your mailing address.
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| Part 6. Declaration of Intention. 8. Mailing Address. Select State from List of States | ComboBox |
Select the state for your mailing address from the provided list of states.
AE
DE
FL
MI
NH
WY
NY
DC
CO
MS
IN
UT
SD
WA
WI
GU
HI
NE
OH
TN
CA
OR
VA
IL
MH
MO
NM
NV
GA
KS
RI
SC
NJ
KY
VI
LA
ME
MP
MT
PW
PR
WV
AA
FM
IA
AL
AZ
TX
VT
AR
ND
MN
AP
MD
PA
AK
AS
MA
NC
ID
CT
OK
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| Part 6. Declaration of Intention. 8. Mailing Address. Enter Zip Code | Text |
Enter the ZIP code for your mailing address. The ZIP code should be 5 digits long.
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| Part 6. Declaration of Intention. 8. Mailing Address. Enter In Care Of Name, if any | Text |
Enter the name of the person or entity 'In Care Of' for your mailing address, if applicable. This field can contain up to 34 characters.
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| Personal Information | ||
| Part 1. Information About You. 4. Enter U S C I S Online Account Number, if any. 12 characters | Text |
Enter your USCIS Online Account Number, if you have one. This number is used to access your USCIS online account.
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| Part 1. Information About You. 1. Your Current Legal Name (Do not provide a nickname). Enter Family Name (Last Name) | Text |
Enter your current legal family name (last name). Do not provide a nickname.
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| Part 1. Information About You. 1. Your Current Legal Name (Do not provide a nickname). Enter Given Name (First Name) | Text |
Enter your current legal given name (first name). Do not provide a nickname.
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| Part 1. Information About You. 1. Your Current Legal Name (Do not provide a nickname). Enter Middle Name | Text |
Enter your current legal middle name, if you have one. Do not provide a nickname.
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| Part 1. Information About You. 7. Enter Country of Birth | Text |
Enter the country where you were born.
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| Part 1. Information About You. 3. Enter U. S. Social Security Number, if any. 9 digits | Text |
Enter your U.S. Social Security Number, if you have one. This number should be 9 digits long.
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| Part 1. Information About You. Enter Your 9 Digit A. Number | Text |
Enter your 9-digit Alien Registration Number (A-Number). This number is assigned to you by the USCIS.
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| Part 1. Information About You. 6. Enter Date You Became a Lawful Permanent Resident. Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date you became a lawful permanent resident in the format MM/DD/YYYY.
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| Part 1. Information About You. 2. Other Names Used, if any. Provide all other names you have ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this section, use the space provided in Part 5. Additional Information. Line One. Enter Middle Name | Text |
Enter any middle names you have used, including aliases, maiden names, and nicknames. Use Part 5 for additional space if needed.
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| Part 1. Information About You. 2. Other Names Used, if any. Provide all other names you have ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this section, use the space provided in Part 5. Additional Information. Line One. Enter Given Name (First Name) | Text |
Enter any given names (first names) you have used, including aliases, maiden names, and nicknames. Use Part 5 for additional space if needed.
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| Part 1. Information About You. 2. Other Names Used, if any. Provide all other names you have ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this section, use the space provided in Part 5. Additional Information. Line One. Enter Family Name (Last Name) | Text |
Enter any family names (last names) you have used, including aliases, maiden names, and nicknames. Use Part 5 for additional space if needed.
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| Part 1. Information About You. 2. Other Names Used, if any. Provide all other names you have ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this section, use the space provided in Part 5. Additional Information. Line Two. Enter Middle Name | Text |
Enter any middle names you have used, including aliases, maiden names, and nicknames. This is for the second line of additional names. Use Part 5 for additional space if needed.
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| Part 1. Information About You. 2. Other Names Used, if any. Provide all other names you have ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this section, use the space provided in Part 5. Additional Information. Line Two. Enter Given Name (First Name) | Text |
Enter any given names (first names) you have used, including aliases, maiden names, and nicknames. This is for the second line of additional names. Use Part 5 for additional space if needed.
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| Part 1. Information About You. 2. Other Names Used, if any. Provide all other names you have ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this section, use the space provided in Part 5. Additional Information. Line Two. Enter Family Name (Last Name) | Text |
Enter any family names (last names) you have used, including aliases, maiden names, and nicknames. This is for the second line of additional names. Use Part 5 for additional space if needed.
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| Part 1. Information About You. 5. Enter Date of Birth. Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter your date of birth in the format MM/DD/YYYY.
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| Part 1. Information About You. Enter 9 Digit A. Number | Text |
Enter your 9-digit Alien Registration Number (A-Number).
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| Part 1. Information About You. 10. Mailing Address. Enter In Care Of Name, if any | Text |
Enter the name of the person or entity in whose care the mailing address is, if applicable.
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| Part 5. Additional Information. If you need extra space to provide any additional information within this application, 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 application 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. Family Name (Last Name). This field is pre-populated from Page 1 | Text |
This field is pre-populated with your family name (last name) from Page 1. Ensure it is correct.
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| Part 5. Additional Information. 1. Given Name (First Name). This field is pre-populated from Page 1 | Text |
This field is pre-populated with your given name (first name) from Page 1. Ensure it is correct.
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| Part 5. Additional Information. 1. Middle Name. This field is pre-populated from Page 1 | Text |
This field is pre-populated with your middle name from Page 1. Ensure it is correct.
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| Part 6. Declaration of Intention. Enter Your 9 Digit A. Number | Text |
Enter your 9-digit Alien Registration Number (A-Number).
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| Physical Address | ||
| Part 6. Declaration of Intention. 9. Physical Address. Enter Street Number and Name (Do not provide a P O Box in this space unless it is your ONLY address) | Text |
Enter the street number and name of your physical address. Do not use a P.O. Box unless it is your only address.
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| Part 6. Declaration of Intention. 9. Physical Address. Select Apartment | CheckBox |
Select this checkbox if your physical address includes an apartment.
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| Part 6. Declaration of Intention. 9. Physical Address. Select Suite | CheckBox |
Select this checkbox if your physical address includes a suite.
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| Part 6. Declaration of Intention. 9. Physical Address. Select Floor | CheckBox |
Select this checkbox if your physical address includes a floor number.
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| Part 6. Declaration of Intention. 9. Physical Address. Enter Apartment, Suite or Floor Number | Text |
Enter the apartment, suite, or floor number of your physical address.
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| Part 6. Declaration of Intention. 9. Physical Address. Enter City or Town | Text |
Enter the city or town for your physical address. This field can contain up to 20 characters.
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| Part 6. Declaration of Intention. 9. Physical Address. Select State from List of States | ComboBox |
Select the state for your physical address from the provided list of states.
AE
DE
FL
MI
NH
WY
NY
DC
CO
MS
IN
UT
SD
WA
WI
GU
HI
NE
OH
TN
CA
OR
VA
IL
MH
MO
NM
NV
GA
KS
RI
SC
NJ
KY
VI
LA
ME
MP
MT
PW
PR
WV
AA
FM
IA
AL
AZ
TX
VT
AR
ND
MN
AP
MD
PA
AK
AS
MA
NC
ID
CT
OK
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| Part 6. Declaration of Intention. 9. Physical Address. Enter Zip Code | Text |
Enter the ZIP code for your physical address. The ZIP code should be 5 digits long.
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| Preparer Information | ||
| Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Provide the following information about the preparer. Preparer's Full Name. 1. Enter Preparer's Given Name (First Name) | Text |
Enter the given name (first name) of the person who prepared the application, if it is someone other than the applicant.
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| Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. 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 who prepared the application, if it is someone other than the applicant.
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| Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Provide the following information about the preparer. 2. Enter Preparer's Business or Organization Name, if any | Text |
Enter the business or organization name of the preparer, if applicable.
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| Preparer's Certification | ||
| Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Certification. 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 | Text |
Enter the preparer's signature. This form cannot be signed electronically, and the name of the preparer cannot be typewritten into this space.
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| Preparer's Information | ||
| Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Enter Your 9 Digit A. Number | Text |
Enter your 9-digit Alien Registration Number (A-Number).
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| Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Signature. 8. Enter Date of Signature. Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date when the preparer signed the application. Use the format MM/DD/YYYY.
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| Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Contact Information. 6. Enter Preparer's Email Address, if any | Text |
Enter the email address of the person who prepared the application, if available.
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| Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Contact Information. 4. Enter Preparer's Daytime Telephone Number. Enter 10 digit number | Text |
Enter the daytime telephone number of the person who prepared the application. Use a 10-digit format.
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| Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Contact Information. 5. Enter Preparer's Mobile Telephone Number, if any. Enter 10 digit number | Text |
Enter the mobile telephone number of the person who prepared the application, if available. Use a 10-digit format.
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| Preparer's Mailing Address | ||
| Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Mailing Address. 3. Enter City or Town | Text |
Enter the city or town of the preparer's mailing address.
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| Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Mailing Address. 3. Enter Province | Text |
Enter the province of the preparer's mailing address.
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| Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Mailing Address. 3. Enter Postal Code | Text |
Enter the postal code of the preparer's mailing address.
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| Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Mailing Address. 3. Enter Zip Code | Text |
Enter the ZIP code of the preparer's mailing address.
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| Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. 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.
AE
DE
FL
MI
NH
WY
NY
DC
CO
MS
IN
UT
SD
WA
WI
GU
HI
NE
OH
TN
CA
OR
VA
IL
MH
MO
NM
NV
GA
KS
RI
SC
NJ
KY
VI
LA
ME
MP
MT
PW
PR
WV
AA
FM
IA
AL
AZ
TX
VT
AR
ND
MN
AP
MD
PA
AK
AS
MA
NC
ID
CT
OK
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| Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Mailing Address. 3. Enter Street Number and Name | Text |
Enter the street number and name of the preparer's mailing address.
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| Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Mailing Address. 3. Select Suite | CheckBox |
Select this checkbox if the preparer's mailing address includes a suite.
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| Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Mailing Address. 3. Select Floor | CheckBox |
Select this checkbox if the preparer's mailing address includes a floor.
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| Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. 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.
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| Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Mailing Address. 3. Select Apartment | CheckBox |
Select this checkbox if the preparer's address includes an apartment.
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| Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Mailing Address. 3. Enter Country | Text |
Enter the country of the preparer's mailing address.
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| Preparer's Statement | ||
| Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Statement. 7. A. Select I am not an attorney or accredited representative but have prepared this application on behalf of the applicant and with the applicant's consent | CheckBox |
Select this checkbox if you are not an attorney or accredited representative but have prepared this application on behalf of the applicant with their consent.
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| Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. 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 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Statement. 7. B. Select I am an attorney or accredited representative and my representation of the applicant in this case does not extend beyond the preparation of this application | CheckBox |
Select this checkbox if you are an attorney or accredited representative and your representation of the applicant does not extend beyond the preparation of this application.
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| Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Statement. 7. B. Select I am an attorney or accredited representative and my representation of the applicant in this case extends beyond the preparation of this application. NOTE: If you are an attorney or accredited representative, you may need to submit a completed Form G - 28, Notice of Entry of Appearance as Attorney or Accredited Representative, with this application | CheckBox |
Select this checkbox if you are an attorney or accredited representative and your representation of the applicant extends beyond the preparation of this application. Note: You may need to submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, with this application.
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| USCIS Officer's Signature | ||
| Part 6. Declaration of Intention. Applicant's and U S C I S Officer's Signature. 16. U S C I S Officer's Signature. This form can not be signed electronically. The name of the U S C I S Officer can not be typewritten into this space | Text |
This section is for the USCIS officer's signature. This form cannot be signed electronically, and the name of the USCIS officer cannot be typewritten into this space.
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| Part 6. Declaration of Intention. Applicant's and U S C I S Officer's Signature. 16. Enter Date of Signature. Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date of the USCIS officer's signature in the format MM/DD/YYYY.
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