Form N-600, Application for Certificate of Citizenship Instructions
This form contains 457 fields organized into 76 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Absence from the U.S. | ||
| Part 2. Information About You. 22. Have you been absent from the United States since you first arrived? Select No | CheckBox |
Indicate whether you have been absent from the United States since you first arrived by selecting 'No'.
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| Part 2. Information About You. 22. Have you been absent from the United States since you first arrived? Select Yes | CheckBox |
Indicate whether you have been absent from the United States since you first arrived by selecting 'Yes'.
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| Additional Information | ||
| Part 11. Additional Information. If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Include 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. 5. D. Enter Additional Information | Text |
Use this space to provide any additional information that is relevant to your petition. If you need more space, you may make copies of this page or attach a separate sheet of paper. Include your name and A-Number (if any) at the top of each sheet, and indicate the Page Number, Part Number, and Item Number to which your answer refers. Sign and date each sheet.
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| Part 11. Additional Information. If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Include 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. 6. A. Enter Page Number | Text |
Enter the page number for the additional information you are providing.
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| Part 11. Additional Information. If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Include 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. 6. B. Enter Part Number | Text |
Enter the part number for which you are providing additional information. This is used to reference the specific section of the form that your additional information pertains to.
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| Part 11. Additional Information. If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Include 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. 6. C. Enter Item Number | Text |
Enter the item number for which you are providing additional information. This helps to identify the exact question or item on the form that your additional information relates to.
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| Part 11. Additional Information. If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Include 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. 6. D. Enter Additional Information | Text |
Provide any additional information that is relevant to your application. Make sure to reference the part and item number that this information pertains to.
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| Part 11. Additional Information. If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Include 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. 5. C. Enter Item Number | Text |
Enter the item number for which you are providing additional information. This helps to identify the exact question or item on the form that your additional information relates to.
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| Part 11. Additional Information. If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Include 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. 5. B. Enter Part Number | Text |
Enter the part number for which you are providing additional information. This is used to reference the specific section of the form that your additional information pertains to.
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| Part 11. Additional Information. If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Include 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. 5. A. Enter Page Number | Text |
Enter the page number where the additional information is provided.
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| Part 11. Additional Information. If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Include 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. 2. Enter Alien Registration Number (A. Number), if any | Text |
Enter your Alien Registration Number (A. Number), if you have one.
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| Part 11. Additional Information. If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Include 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. 3. A. Enter Page Number | Text |
Enter the page number where the additional information is provided.
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| Part 11. Additional Information. If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Include 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. 3. B. Enter Part Number | Text |
Enter the part number where the additional information is provided.
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| Part 11. Additional Information. If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Include 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. 3. C. Enter Item Number | Text |
Enter the item number where the additional information is provided.
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| Part 11. Additional Information. If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Include 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. 3. D. Enter Additional Information | Text |
Provide any additional information that is relevant to your application. If you need more space, you can attach additional sheets. Make sure to include your name and A-Number (if any) at the top of each sheet, and indicate the Page Number, Part Number, and Item Number to which your answer refers. Sign and date each sheet.
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| Part 11. Additional Information. If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Include 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. 4. A. Enter Page Number | Text |
Enter the page number of the form where you are providing additional information. This field has a maximum length of 2 characters.
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| Part 11. Additional Information. If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Include 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. 4. B. Enter Part Number | Text |
Enter the part number for which you are providing additional information. This is used to reference the specific section of the form that your additional information pertains to.
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| Part 11. Additional Information. If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Include 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. 4. C. Enter Item Number | Text |
Enter the item number for which you are providing additional information. This helps to identify the exact question or item on the form that your additional information addresses.
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| Part 11. Additional Information. If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Include 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. 4. D. Enter Additional Information | Text |
Provide any additional information that is relevant to your application. If you need more space, you can attach additional sheets with your name and A-Number at the top.
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| Admission and Immigration Status | ||
| Part 2. Information About You. 14. Information About Your Admission into the United States and Current Immigration Status. A. I arrived in the following manner. Port-of-Entry. Enter City or Town | Text |
Enter the city or town where you arrived in the United States.
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| Part 2. Information About You. 14. Information About Your Admission into the United States and Current Immigration Status. A. I arrived in the following manner. Port-of-Entry. Select State from a List of States | ComboBox |
Select the state from the provided list where you arrived in the United States.
MP
PA
FM
MH
MN
CO
ND
RI
NE
NM
FL
MS
OR
WA
MT
AA
AK
DE
VT
SC
IL
CA
MD
PR
UT
VI
NV
AS
AE
NH
PW
SD
WY
CT
KS
MA
MI
AR
VA
IA
ID
TN
KY
GU
AP
WV
GA
HI
NY
AL
IN
OK
WI
NJ
OH
TX
NC
DC
LA
ME
MO
AZ
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| Part 2. Information About You. 14. Information About Your Admission into the United States and Current Immigration Status. A. I arrived in the following manner. Port-of-Entry. Enter Date of Entry as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date you arrived in the United States in the format MM/DD/YYYY.
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| Part 2. Information About You. 14. Information About Your Admission into the United States and Current Immigration Status. A. I arrived in the following manner. Exact Name Used at Time of Entry. Enter Middle Name, if applicable | Text |
Enter your middle name as it was at the time of your entry into the United States, if applicable.
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| Part 2. Information About You. 14. Information About Your Admission into the United States and Current Immigration Status. A. I arrived in the following manner. Exact Name Used at Time of Entry. Enter Given Name (First Name) | Text |
Enter your given name (first name) as it was at the time of your entry into the United States.
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| Part 2. Information About You. 14. Information About Your Admission into the United States and Current Immigration Status. A. I arrived in the following manner. Exact Name Used at Time of Entry. Enter Family Name (Last Name) | Text |
Enter your family name (last name) as it was at the time of your entry into the United States.
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| Adoption Details | ||
| Part 2. Information About You. 18. Did you have to be re-adopted in the United States? D. Date Physical Custody Began (mm/dd/yyyy) | Text |
Enter the date when your physical custody began in the United States. Use the format mm/dd/yyyy.
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| Part 2. Information About You. 17. Were you adopted? C. Date Legal Custody Began (mm/dd/yyyy). Enter Date as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date when your legal custody began. Use the format mm/dd/yyyy.
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| Part 2. Information About You. 17. Were you adopted? D. Date Physical Custody Began (mm/dd/yyyy) | Text |
Enter the date when your physical custody began. Use the format mm/dd/yyyy.
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| Part 2. Information About You. 17. Were you adopted? B. Date of Adoption (mm/dd/yyyy). Enter To Date as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date of your adoption. Use the format mm/dd/yyyy.
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| Adoption Information | ||
| Part 2. Information About You. 17. Were you adopted? Check No | CheckBox |
Check this box if you were not adopted.
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| Part 2. Information About You. 17. Were you adopted? Check Yes | CheckBox |
Check this box if you were adopted.
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| Part 2. Information About You. 17. Were you adopted? A. Place of Final Adoption. Enter City or Town | Text |
Enter the city or town where your final adoption took place.
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| Part 2. Information About You. 18. Did you have to be re-adopted in the United States? Check No | CheckBox |
Check this box if you did not have to be re-adopted in the United States.
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| Part 2. Information About You. 18. Did you have to be re-adopted in the United States? Check Yes. If you answered "Yes" to Item Number 18., complete Items A. - D | CheckBox |
Check this box if you had to be re-adopted in the United States. If you answered 'Yes', complete Items A - D.
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| Part 2. Information About You. 18. Did you have to be re-adopted in the United States? B. Date of Final Adoption (mm/dd/yyyy).Enter To Date as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date of your final adoption in the United States in the format MM/DD/YYYY.
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| Part 2. Information About You. 17. Were you adopted? A. Place of Final Adoption. Select State from a List of States | ComboBox |
Select the state where your final adoption took place from the provided list of states.
MP
PA
FM
MH
MN
CO
ND
RI
NE
NM
FL
MS
OR
WA
MT
AA
AK
DE
VT
SC
IL
CA
MD
PR
UT
VI
NV
AS
AE
NH
PW
SD
WY
CT
KS
MA
MI
AR
VA
IA
ID
TN
KY
GU
AP
WV
GA
HI
NY
AL
IN
OK
WI
NJ
OH
TX
NC
DC
LA
ME
MO
AZ
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| Part 2. Information About You. 17. Were you adopted? A. Place of Final Adoption. Enter City or Town | Text |
Enter the city or town where your final adoption took place. Maximum length is 40 characters.
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| Affidavit | ||
| Part 12. Affidavit (do NOT complete this part unless instructed to do so at the interview). I, the (applicant, parent, or legal guardian) do swear or affirm, under penalty of perjury under the laws of the United States, that I know and understand the contents of this application signed by me, and the attached supplementary pages number to inclusive, that the same are true and correct to the best of my knowledge, and that corrections number to were made by me or at my request. Enter Applicant, Parent or Legal guardian name | Text |
Enter the name of the applicant, parent, or legal guardian who is swearing or affirming the affidavit. This section should only be completed if instructed to do so at the interview.
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| Part 12. Affidavit (do NOT complete this part unless instructed to do so AT THE INTERVIEW). I swear (affirm) and certify under penalty of perjury under the laws of the United States of America that I know that the contents of this Form N-400, Application for Naturalization, subscribed by me, including corrections number 1 through: [Enter Total Number of Corrections] are true and correct | Text |
Enter the total number of corrections made to the form. This section is part of the affidavit and should only be completed if instructed to do so at the interview.
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| Part 12. Affidavit (do NOT complete this part unless instructed to do so AT THE INTERVIEW). I swear (affirm) and certify under penalty of perjury under the laws of the United States of America that I know that the contents of this Form N-400, Application for Naturalization, subscribed by me, including corrections number 1 through: [Enter Total Number of Corrections] are true and correct | Text |
Enter the total number of corrections made to the Form N-400, Application for Naturalization. This part should only be completed if instructed to do so at the interview.
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| Part 12. Affidavit (do NOT complete this part unless instructed to do so | Text |
This field is part of the affidavit section and should only be completed if instructed to do so at the interview.
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| Part 12. Affidavit (do NOT complete this part unless instructed to do so | Text |
This field is part of the affidavit section and should only be completed if instructed to do so at the interview.
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| Part 12. Affidavit (do NOT complete this part unless instructed to do so at the interview). Applicant's, Parent's or Legal Guardian's Signature. This form can not be signed electronically. The name of the preparer can not be typewritten into this space | Text |
Provide the signature of the applicant, parent, or legal guardian. This form cannot be signed electronically, and the name of the preparer cannot be typewritten into this space. Complete this part only if instructed to do so at the interview.
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| Part 12. Affidavit (do NOT complete this part unless instructed to do so at the interview). Date of Signature. Enter the 2 digit month, 2 digit day and 4 digit year | Text |
Enter the date of signature in the format of 2-digit month, 2-digit day, and 4-digit year. Complete this part only if instructed to do so at the interview.
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| Part 12. Affidavit (do NOT complete this part unless instructed to do so at the interview). Enter Applicant's Printed Name | Text |
Enter the printed name of the applicant. Complete this part only if instructed to do so at the interview.
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| Part 12. Affidavit (do NOT complete this part unless instructed to do so at the interview). U S C I S Officer's Signature. No Entry. Print and Sign completed form | Text |
This field is for the USCIS officer's signature. No entry is required from the applicant. Print and sign the completed form.
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| Part 12. Affidavit (do NOT complete this part unless instructed to do so at the interview). Enter U S C I S Officer's Title | Text |
Enter the title of the USCIS officer. Complete this part only if instructed to do so at the interview.
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| Part 12. Affidavit (do NOT complete this part unless instructed to do so at the interview). Enter Date of Signature as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date of the USCIS officer's signature in the format of 2-digit month, 2-digit day, and 4-digit year. Complete this part only if instructed to do so at the interview.
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| Part 12. Affidavit (do NOT complete this part unless instructed to do so at the interview). Enter the 2 digit month, 2 digit day and 4 digit year | Text |
Enter the date of signature in the format MM/DD/YYYY. Do not complete this part unless instructed to do so at the interview.
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| Part 12. Affidavit (do NOT complete this part unless instructed to do so at the interview) Enter location | Text |
Enter the location where the affidavit is being completed. Do not complete this part unless instructed to do so at the interview.
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| Alien Registration | ||
| Page 10. Alien Registration Number (A-Number). No Entry | Text |
Enter your Alien Registration Number (A-Number). The number should be 9 digits long.
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| Applicant Information | ||
| Part 2. Information About You.3. Other Names You Have Used Since Birth. Provide all other names you have ever used, include nicknames, maiden name, and aliases. Middle Name | Text |
Provide any middle names you have used since birth, including nicknames, maiden names, and aliases.
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| Part 2. Information About You.3. Other Names You Have Used Since Birth. Provide all other names you have ever used, include nicknames, maiden name, and aliases. Given Name (First Name) | Text |
Provide any first names you have used since birth, including nicknames, maiden names, and aliases.
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| Part 2. Information About You.3. Other Names You Have Used Since Birth. Provide all other names you have ever used, include nicknames, maiden name, and aliases. Family Name (Last Name) | Text |
Provide any last names you have used since birth, including nicknames, maiden names, and aliases.
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| Part 2. Information About You.3. Other Names You Have Used Since Birth. Provide all other names you have ever used, include nicknames, maiden name, and aliases. Middle Name | Text |
Provide any middle names you have used since birth, including nicknames, maiden names, and aliases.
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| Part 2. Information About You.3. Other Names You Have Used Since Birth. Provide all other names you have ever used, include nicknames, maiden name, and aliases. Given Name (First Name) | Text |
Provide any first names you have used since birth, including nicknames, maiden names, and aliases.
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| Part 2. Information About You. 3. Other Names You Have Used Since Birth. Provide all other names you have ever used, include nicknames, maiden name, and aliases. Family Name (Last Name) | Text |
Provide any last names you have used since birth, including nicknames, maiden names, and aliases.
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| Page 2. Alien Registration Number (A-Number). No Entry | Text |
Enter the Alien Registration Number (A-Number) if applicable.
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| Part 2. Information About You. 11. Physical Address. Enter City | Text |
Enter the city of your physical address.
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| Page 7. Alien Registration Number (A-Number). No Entry | Text |
Enter your Alien Registration Number (A-Number). This is a unique identifier assigned to non-citizens by the U.S. Citizenship and Immigration Services (USCIS). It is typically a 9-digit number.
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| Page 7. Alien Registration Number (A-Number). No Entry | Text |
Enter your Alien Registration Number (A-Number). This is a unique identifier assigned to non-citizens by the U.S. Citizenship and Immigration Services (USCIS). It is typically a 9-digit number.
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| Applicant's Certification | ||
| Part 8. Applicant's Statement, Contact Information, Certification, and Signature. I understand that USCIS may require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or signature) and, at that time, if I am required to provide biometrics, I will be required to sign an oath reaffirming that: 1) I reviewed and provided or authorized all of the information in my application; 2) I understood all of the information contained in, and submitted with, my application; and 3) All of this information was complete, true, and correct at the time of filing. I certify, under penalty of perjury, that I provided or authorized all of the information in my application, I understand all of the information contained in, and submitted with, my application, and that all of this information is complete, true, and correct. Applicant's Signature. This form can not be signed electronically. The name of the applicant can not be typewritten into this space. If the applicant is a minor child, the parent must sign the child's name in this space. This form will be rejected without a signature in this space | Text |
Sign this form to certify that all the information provided is complete, true, and correct. Note that this form cannot be signed electronically and must be signed by the applicant or the parent if the applicant is a minor.
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| Applicant's Contact Information | ||
| Part 8. Applicant's Statement, Contact Information, 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 8. Applicant's Statement, Contact Information, Certification, and Signature. Applicant's Contact Information. 3. Enter Applicant's Daytime Telephone Number | Text |
Enter your daytime telephone number. The number should be 10 digits long.
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| Part 8. Applicant's Statement, Contact Information, Certification, and Signature. Applicant's Contact Information. 4. Enter Applicant's Mobile Telephone Number (if any) | Text |
Enter your mobile telephone number, if you have one. The number should be 10 digits long.
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| Applicant's Information | ||
| Page 5. Alien Registration Number (A-Number). No Entry | Text |
Enter your Alien Registration Number (A-Number). This number is typically 9 digits long.
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| Page 9. Alien Registration Number (A-Number). No Entry | Text |
Enter your Alien Registration Number (A-Number). This number is typically 9 digits long.
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| Page 2. Alien Registration Number (A-Number). No Entry | Text |
Enter the Alien Registration Number (A-Number) of the applicant. This number is typically 9 digits long.
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| Page 2. Alien Registration Number (A-Number). No Entry | Text |
Enter your Alien Registration Number (A-Number). This number is typically 9 digits long.
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| Applicant's Marital History | ||
| Part 9. Information About Your Marital History. 7. If your current spouse is not a U. S. citizen, complete the following information. C. Current Spouse's Immigration Status. Check Lawful Permanent Resident | CheckBox |
Check this box if your current spouse is a lawful permanent resident.
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| Applicant's Personal Information | ||
| Page 6. Alien Registration Number (A-Number). No Entry | Text |
Enter your Alien Registration Number (A-Number). This number is typically 9 digits long.
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| Applicant's Statement | ||
| Part 8. Applicant's Statement, Contact Information, Certification, and Signature. NOTE: Read the Penalties section of the Form N-600 Instructions before completing this part. 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. 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. Check Box | CheckBox |
Check this box if you can read and understand English and have read and understood each question and instruction on this form, as well as your answers.
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| Applicant's Statement. Part 8. Applicant's Statement, Contact Information, Certification, and Signature. NOTE: Read the Penalties section of the Form N-600 Instructions before completing this part. 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. The interpreter named in Part 9. read to me every question and instruction on this application and my answer to every question, in the blank language, a language in which I am fluent and I understood everything. Check box | CheckBox |
Check this box if an interpreter read every question and instruction on this application to you in a language in which you are fluent, and you understood everything.
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| Part 8. Applicant's Statement, Contact Information, Certification, and Signature. 1. Applicant's Statement Regarding the Interpreter. B. Enter specified language | Text |
Enter the language in which the interpreter read the application to you.
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| Part 8. Applicant's Statement, Contact Information, Certification, and Signature. NOTE: Read the Penalties section of the Form N-600 Instructions before completing this part. 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. At my request, the preparer named in Part 10., prepared this application for me based only upon information I provided or authorized | CheckBox |
Check this box if the preparer named in Part 10 prepared this application for you based only on the information you provided or authorized.
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| Part 8. Applicant's Statement, Contact Information, Certification, and Signature. 2. Applicant's Statement Regarding the Preparer. Enter the preparer named in Part 10., here | Text |
Enter the name of the preparer who helped you complete this application, as mentioned in Part 10.
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| Applicant's Statement and Signature | ||
| Part 8. Applicant's Statement, Contact Information, Certification, and Signature. Applicant's Signature. Date of Signature. Enter the 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 Information | ||
| Attorney State Bar Number (if applicable) | Text |
Enter the state bar number of the attorney representing you, if applicable.
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| Attorney or Accredited Representative U S C I S E L I S Account Number (if any) | Text |
Enter the USCIS ELIS account number of the attorney or accredited representative, if any.
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| Barcode | ||
| PDF417BarCode1 | Text |
This is a barcode field that contains encoded information about the form.
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| Biographic Information | ||
| Part 3. Biographic Information. 3. Height. Enter Feet | ComboBox |
Select your height in feet from the provided options.
6
8
9
1
7
2
4
5
3
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| Part 3. Biographic Information. 3. Height. Enter Inches | ComboBox |
Select your height in inches from the provided options.
6
10
8
9
1
7
2
4
5
11
3
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| Part 3. Biographic Information. 2. Race (Select one or more). Check American Indian or Alaska Native | CheckBox |
Check this box if you identify as American Indian or Alaska Native.
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| Part 3. Biographic Information. 2. Race (Select one or more). Check Asian | CheckBox |
Check this box if you identify as Asian.
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| Part 3. Biographic Information. 2. Race (Select one or more). Check Black or African American | CheckBox |
Select this checkbox if your race is Black or African American.
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| Part 3. Biographic Information. 2. Race (Select one or more). Check Native Hawaiian or Other Pacific Islander | CheckBox |
Select this checkbox if your race is Native Hawaiian or Other Pacific Islander.
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| Part 3. Biographic Information. 2. Race (Select all applicable boxes). Check White | CheckBox |
Select this checkbox if your race is White.
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| Part 3. Biographic Information. 1. Ethnicity (Select only one box). Check Not Hispanic or Latino | CheckBox |
Select this checkbox if your ethnicity is Not Hispanic or Latino.
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| Part 3. Biographic Information. 1. Ethnicity (Select only one box). Select Hispanic or Latino | CheckBox |
Select this checkbox if your ethnicity is Hispanic or Latino.
|
| Part 3. Biographic Information. 4. Weight in Pounds Enter First Digit of Weight | Text |
Enter the first digit of your weight in pounds.
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| Part 3. Biographic Information. 4. Weight in Pounds Enter Second Digit of Weight | Text |
Enter the second digit of your weight in pounds.
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| Part 3. Biographic Information. 4. Weight in Pounds Enter Third Digit of Weight | Text |
Enter the third digit of your weight in pounds.
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| Part 3. Biographic Information. 5. Eye color. Check Brown | CheckBox |
Select this checkbox if your eye color is Brown.
|
| Part 3. Biographic Information. 5. Eye color. Check Blue | CheckBox |
Select this checkbox if your eye color is Blue.
|
| Part 3. Biographic Information. 5. Eye color. Check Green | CheckBox |
Select this checkbox if your eye color is Green.
|
| Part 3. Biographic Information. 5. Eye color. Check Hazel | CheckBox |
Select this checkbox if your eye color is Hazel.
|
| Part 3. Biographic Information. 5. Eye color. Check Gray | CheckBox |
Select this checkbox if your eye color is Gray.
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| Part 3. Biographic Information. 5. Eye color. Check Black | CheckBox |
Select this checkbox if your eye color is black.
|
| Part 3. Biographic Information. 5. Eye color. Check Pink | CheckBox |
Select this checkbox if your eye color is pink.
|
| Part 3. Biographic Information. 5. Eye color. Check Maroon | CheckBox |
Select this checkbox if your eye color is maroon.
|
| Part 3. Biographic Information. 5. Eye color. Check Other | CheckBox |
Select this checkbox if your eye color is not listed and specify the color.
|
| Part 3. Biographic Information. 6. Hair Color. Check Bald (No hair) | CheckBox |
Select this checkbox if you are bald and have no hair.
|
| Part 3. Biographic Information. 6. Hair Color. Check Sandy | CheckBox |
Select this checkbox if your hair color is sandy.
|
| Part 3. Biographic Information. 6. Hair Color. Check Red | CheckBox |
Select this checkbox if your hair color is red.
|
| Part 3. Biographic Information. 6. Hair Color. Check White | CheckBox |
Select this checkbox if your hair color is white.
|
| Part 3. Biographic Information. 6. Hair Color. Check Gray | CheckBox |
Select this checkbox if your hair color is gray.
|
| Part 3. Biographic Information. 6. Hair Color. Check Blonde | CheckBox |
Select this checkbox if your hair color is blonde.
|
| Part 3. Biographic Information. 6. Hair Color. Check Brown | CheckBox |
Select this checkbox if your hair color is brown.
|
| Part 3. Biographic Part 3. Biographic Information. 6. Hair Color. Check Black | CheckBox |
Select this checkbox if your hair color is black.
|
| Part 3. Biographic Information. 6. Hair Color. Check Other | CheckBox |
Select this checkbox if your hair color is not listed and specify the color.
|
| Child Information | ||
| Part 2. Information About the Child (for whom this application is being filed). 6. Date of Birth (mm/dd/yyyy) | Text |
Enter the date of birth of the child for whom this application is being filed in the format mm/dd/yyyy.
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| Part 2. Information About the Child (for whom this application is being filed). 7. Country of Birth | Text |
Enter the country of birth of the child for whom this application is being filed.
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| Part 2. Information About the Child (for whom this application is being filed). 4. U.S. Social Security Number (if applicable) | Text |
Enter the U.S. Social Security Number of the child for whom this application is being filed, if applicable. This should be a 9-digit number.
|
| Part 2. Information About the Child (for whom this application is being filed) USCIS Online Account Number (if any) | Text |
Enter the USCIS Online Account Number of the child for whom this application is being filed, if any. This should be a 12-digit number.
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| Part 2. Information About the Child (for whom this application is being filed). 9. Male | CheckBox |
Select this checkbox if the child for whom this application is being filed is male.
|
| Part 2. Information About the Child (for whom this application is being filed). 9. Female | CheckBox |
Select this checkbox if the child for whom this application is being filed is female.
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| Part 2. Information About the Child (for whom this application is being filed). 8. Country of Citizenship or Nationality | Text |
Enter the country of citizenship or nationality of the child for whom this application is being filed.
|
| Eligibility Information | ||
| Part 1. Information About Your Eligibility. 1. This application is being filed based on the fact that: (Select only one box). Select Other (Explain fully) | CheckBox |
Select this checkbox if you are filing the application based on a reason other than being a biological or adopted child of a U.S. citizen parent. Provide a full explanation in the space provided.
|
| Part 1. Information About Your Eligibility. 1. This application is being filed based on the fact that: (Select only one box). Check I am an ADOPTED child of a U.S. citizen parent | CheckBox |
Select this checkbox if you are filing the application as an adopted child of a U.S. citizen parent.
|
| Part 1. Information About Your Eligibility. 1. This application is being filed based on the fact that: (Select only one box). Check I am a BIOLOGICAL child of a U.S. citizen parent | CheckBox |
Select this checkbox if you are filing the application as a biological child of a U.S. citizen parent.
|
| Part 1. Information About Your Eligibility. Enter Your 9 Digit Alien Registration Number (A-Number) | Text |
Enter your 9-digit Alien Registration Number (A-Number).
|
| Part 1. Information About Your Eligibility. 1. This application is being filed based on the fact that: (Select only one box). Select Other (Explain fully). Enter explanation | Text |
Provide an explanation if you selected 'Other' as the basis for your eligibility.
|
| Employment and Education History | ||
| Part 2. Information About You. List where you have worked or attended school full time or part time during the last 5 years. Provide information for the complete time period. Include all military, police, and/or intelligence service. Begin by providing information about your most recent or current employment, studies, or unemployment (if applicable). Provide the locations and dates where you worked, were self-employed, were unemployed, or have studied for the last 5 years. If you worked for yourself, write "self-employed." If you were unemployed, write "unemployed." If you need more space, use an additional sheet or sheets of paper to complete. 1. Enter City | Text |
Enter the city where you have worked, attended school, or were unemployed during the last 5 years. Include all military, police, and/or intelligence service. Start with your most recent or current location.
|
| Part 2. Information About You. List where you have worked or attended school full time or part time during the last 5 years. Provide information for the complete time period. Include all military, police, and/or intelligence service. Begin by providing information about your most recent or current employment, studies, or unemployment (if applicable). Provide the locations and dates where you worked, were self-employed, were unemployed, or have studied for the last 5 years. If you worked for yourself, write "self-employed." If you were unemployed, write "unemployed." If you need more space, use an additional sheet or sheets of paper to complete. 1. Select State from a List of States | ComboBox |
Select the state where you have worked, attended school, or were unemployed during the last 5 years from the provided list. Include all military, police, and/or intelligence service. Start with your most recent or current location.
MP
PA
FM
MH
MN
CO
ND
RI
NE
NM
FL
MS
OR
WA
MT
AA
AK
DE
VT
SC
IL
CA
MD
PR
UT
VI
NV
AS
AE
NH
PW
SD
WY
CT
KS
MA
MI
AR
VA
IA
ID
TN
KY
GU
AP
WV
GA
HI
NY
AL
IN
OK
WI
NJ
OH
TX
NC
DC
LA
ME
MO
AZ
|
| Part 2. Information About You. List where you have worked or attended school full time or part time during the last 5 years. Provide information for the complete time period. Include all military, police, and/or intelligence service. Begin by providing information about your most recent or current employment, studies, or unemployment (if applicable). Provide the locations and dates where you worked, were self-employed, were unemployed, or have studied for the last 5 years. If you worked for yourself, write "self-employed." If you were unemployed, write "unemployed." If you need more space, use an additional sheet or sheets of paper to complete. 1. Zip Code Plus 4. Enter 5-digit Zip Code | Text |
Enter the 5-digit zip code for the location where you have worked, attended school, or were unemployed during the last 5 years. Include all military, police, and/or intelligence service. Start with your most recent or current location.
|
| Part 7. Information About Your Employment and Schools You Attended. List where you have worked or attended school full time or part time during the last 5 years. Provide information for the complete time period. Include all military, police, and/or intelligence service. Begin by providing information about your most recent or current employment, studies, or unemployment (if applicable). Provide the locations and dates where you worked, were self-employed, were unemployed, or have studied for the last 5 years. If you worked for yourself, write "self-employed." If you were unemployed, write "unemployed." If you need more space, use an additional sheet or sheets of paper to complete. 1. Enter City | Text |
Enter the city where you have worked, attended school, or were unemployed during the last 5 years. Include all military, police, and/or intelligence service.
|
| Part 7. Information About Your Employment and Schools You Attended. List where you have worked or attended school full time or part time during the last 5 years. Provide information for the complete time period. Include all military, police, and/or intelligence service. Begin by providing information about your most recent or current employment, studies, or unemployment (if applicable). Provide the locations and dates where you worked, were self-employed, were unemployed, or have studied for the last 5 years. If you worked for yourself, write "self-employed." If you were unemployed, write "unemployed." If you need more space, use an additional sheet or sheets of paper to complete. 1. Select State from a List of States | ComboBox |
Select the state from the provided list where you have worked, studied, or been unemployed during the last 5 years.
MP
PA
FM
MH
MN
CO
ND
RI
NE
NM
FL
MS
OR
WA
MT
AA
AK
DE
VT
SC
IL
CA
MD
PR
UT
VI
NV
AS
AE
NH
PW
SD
WY
CT
KS
MA
MI
AR
VA
IA
ID
TN
KY
GU
AP
WV
GA
HI
NY
AL
IN
OK
WI
NJ
OH
TX
NC
DC
LA
ME
MO
AZ
|
| Part 7. Information About Your Employment and Schools You Attended. List where you have worked or attended school full time or part time during the last 5 years. Provide information for the complete time period. Include all military, police, and/or intelligence service. Begin by providing information about your most recent or current employment, studies, or unemployment (if applicable). Provide the locations and dates where you worked, were self-employed, were unemployed, or have studied for the last 5 years. If you worked for yourself, write "self-employed." If you were unemployed, write "unemployed." If you need more space, use an additional sheet or sheets of paper to complete. 1. Zip Code Plus 4. Enter 5-digit Zip Code | Text |
Enter the 5-digit ZIP code for the location where you have worked, studied, or been unemployed during the last 5 years.
|
| Part 7. Information About Your Employment and Schools You Attended. List where you have worked or attended school full time or part time during the last 5 years. Provide information for the complete time period. Include all military, police, and/or intelligence service. Begin by providing information about your most recent or current employment, studies, or unemployment (if applicable). Provide the locations and dates where you worked, were self-employed, were unemployed, or have studied for the last 5 years. If you worked for yourself, write "self-employed." If you were unemployed, write "unemployed." If you need more space, use an additional sheet or sheets of paper to complete. 1. Zip Code Plus 4. Enter 4-digit Zip Code Extension | Text |
Enter the 4-digit ZIP code extension for the location where you have worked, studied, or been unemployed during the last 5 years.
|
| Employment/School History | ||
| Part 2. Information About You. List where you have worked or attended school full time or part time during the last 5 years. Provide information for the complete time period. Include all military, police, and/or intelligence service. Begin by providing information about your most recent or current employment, studies, or unemployment (if applicable). Provide the locations and dates where you worked, were self-employed, were unemployed, or have studied for the last 5 years. If you worked for yourself, write "self-employed." If you were unemployed, write "unemployed." If you need more space, use an additional sheet or sheets of paper to complete. 1. Zip Code Plus 4. Enter 4-digit Zip Code Extension | Text |
Enter the 4-digit extension of your ZIP code for your most recent or current employment, studies, or unemployment.
|
| Father's Citizenship Information | ||
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 6. My father is a U. S. Citizen by: Check Birth abroad to U. S. citizen parent or parents | CheckBox |
Check this box if your father is a U.S. citizen by birth abroad to U.S. citizen parent or parents.
|
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 6. My father is a U. S. Citizen by: Check Acquisition after birth through naturalization of alien parent or parents | CheckBox |
Check this box if your father is a U.S. citizen by acquisition after birth through naturalization of alien parent or parents.
|
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 6.. My father is a U. S. Citizen by: Check Birth in the United States | CheckBox |
Check this box if your father is a U.S. citizen by birth in the United States.
|
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 6. My father is a U.S. citizen by. Check Naturalization | CheckBox |
Indicate if your father is a U.S. citizen by naturalization by checking this box.
|
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 6. My father is a U.S. citizen by. Enter Alien Registration Number (A-Number) | Text |
Enter your father's Alien Registration Number (A-Number) if he is a U.S. citizen by naturalization.
|
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 6. My father is a U.S. citizen by. Enter Certificate of Naturalization Number | Text |
Enter the Certificate of Naturalization Number of your father if he is a U.S. citizen by naturalization.
|
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 7. Has your father ever lost U.S. citizenship or taken any action that would cause loss of U.S. citizenship? Check No | CheckBox |
Check this box if your father has never lost U.S. citizenship or taken any action that would cause loss of U.S. citizenship.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 7. Has your father ever lost U.S. citizenship or taken any action that would cause loss of U.S. citizenship? Check Yes. If you answered “Yes” to Item Number 7., provide an explanation in Part 11. Additional Information | CheckBox |
Check this box if your father has ever lost U.S. citizenship or taken any action that would cause loss of U.S. citizenship. Provide an explanation in Part 11 if you check this box.
|
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 6. My father is a U.S. citizen by. Select State from the List | ComboBox |
Select the state from the list where your U.S. citizen biological or adoptive father is a citizen.
MP
PA
FM
MH
MN
CO
ND
RI
NE
NM
FL
MS
OR
WA
MT
AA
AK
DE
VT
SC
IL
CA
MD
PR
UT
VI
NV
AS
AE
NH
PW
SD
WY
CT
KS
MA
MI
AR
VA
IA
ID
TN
KY
GU
AP
WV
GA
HI
NY
AL
IN
OK
WI
NJ
OH
TX
NC
DC
LA
ME
MO
AZ
|
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 6. My father is a U.S. citizen by. Enter City or Town | Text |
Enter the city or town where your U.S. citizen biological or adoptive father became a U.S. citizen.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 6. My father is a U.S. citizen by. Enter Date of Naturalization (mm/dd/yyyy). Date as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date when your U.S. citizen biological or adoptive father was naturalized. Use the format mm/dd/yyyy.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 6. My father is a U.S. citizen by. Enter Place of Naturalization (Name of Court or USCIS Office Location) | Text |
Enter the name of the court or USCIS office location where your U.S. citizen biological or adoptive father was naturalized.
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| Father's Current Spouse Information | ||
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. G. Place of Marriage. Select State from a List of States | ComboBox |
Select the state where the marriage of your U.S. citizen father's current spouse took place from the provided list of states.
MP
PA
FM
MH
MN
CO
ND
RI
NE
NM
FL
MS
OR
WA
MT
AA
AK
DE
VT
SC
IL
CA
MD
PR
UT
VI
NV
AS
AE
NH
PW
SD
WY
CT
KS
MA
MI
AR
VA
IA
ID
TN
KY
GU
AP
WV
GA
HI
NY
AL
IN
OK
WI
NJ
OH
TX
NC
DC
LA
ME
MO
AZ
|
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. G. Place of Marriage. Enter City or Town | Text |
Enter the city or town where the marriage of your U.S. citizen father's current spouse took place.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. B. Enter Date of Birth as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date of birth of your U.S. citizen father's current spouse in the format MM/DD/YYYY.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. C. Enter Country of Birth | Text |
Enter the country of birth of your U.S. citizen father's current spouse.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. A. Enter Middle Name, if applicable | Text |
Enter the middle name of your U.S. citizen father's current spouse, if applicable.
|
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. A. Enter Given Name (First Name) | Text |
Enter the given name (first name) of your U.S. citizen father's current spouse.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. A. Enter Family Name (Last Name) | Text |
Enter the family name (last name) of your U.S. citizen father's current spouse.
|
| Father's Information | ||
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 1.Current Legal Name (do not provide a nickname) Middle Name | Text |
Enter the middle name of your U.S. citizen biological or adoptive father. Do not use a nickname.
|
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 1.Current Legal Name (do not provide a nickname) Given Name (First Name) | Text |
Enter the given name (first name) of your U.S. citizen biological or adoptive father. Do not use a nickname.
|
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 1.Current Legal Name (do not provide a nickname)Family Name (Last Name) | Text |
Enter the family name (last name) of your U.S. citizen biological or adoptive father. Do not use a nickname.
|
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). Enter Alien Registration Number (A-Number) | Text |
Enter the Alien Registration Number (A-Number) of your U.S. citizen biological or adoptive father. This number is typically 9 digits long.
|
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). Enter Certificate of Citizenship Number | Text |
Enter the Certificate of Citizenship Number of your U.S. citizen biological or adoptive father. This number can be up to 20 characters long.
|
| Father's Marital History | ||
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 8. Marital History. B. What is your U.S. citizen father's current marital status? Check Marriage Annulled | CheckBox |
Indicate if your U.S. citizen father's current marital status is 'Marriage Annulled' by checking this box.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 8. Marital History. B. What is your U.S. citizen father's current marital status? Check Separated | CheckBox |
Indicate if your U.S. citizen father's current marital status is 'Separated' by checking this box.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 8. Marital History. A. How many times has your U.S. citizen father been married (including annulled marriages and marriages to the same person)? Enter Number of marriages | Text |
Enter the total number of times your U.S. citizen father has been married, including annulled marriages and marriages to the same person.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 8. Marital History. B. What is your U.S. citizen father's current marital status? Check Other | CheckBox |
Indicate if your U.S. citizen father's current marital status is 'Other' by checking this box.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 8. Marital History. B. What is your U.S. citizen father's current marital status? Check Other. Enter Explanation. If you selected "Other," provide an explanation. If you need extra space to complete this section, use the space provided in Part 11. Additional Information | Text |
If you selected 'Other' for your U.S. citizen father's current marital status, provide an explanation here. Use Part 11 for additional space if needed.
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| Father's Marital Status | ||
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 8. Marital History. B. What is your U.S. citizen father's current marital status? Check Divorced | CheckBox |
Check this box if your U.S. citizen father is currently divorced.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 8. Marital History. B. What is your U.S. citizen father's current marital status? Check Single, never married | CheckBox |
Check this box if your U.S. citizen father is currently single and has never been married.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 8. Marital History. B. What is your U.S. citizen father's current marital status? Check Widowed | CheckBox |
Check this box if your U.S. citizen father is currently widowed.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 8. Marital History. B. What is your U.S. citizen father's current marital status? Check Married | CheckBox |
Check this box if your U.S. citizen father is currently married.
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| Father's Personal Information | ||
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 2. Date of Birth (mm/dd/yyyy) | Text |
Enter the date of birth of your U.S. citizen biological or adoptive father. Use the format mm/dd/yyyy.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 3. Country of Birth | Text |
Enter the country of birth of your U.S. citizen biological or adoptive father.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 4. Country of Birth | Text |
Enter the country of birth of your U.S. citizen biological or adoptive father.
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| Father's Physical Address | ||
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 5. Physical Address. Check Floor | CheckBox |
Check this box if the physical address of your U.S. citizen biological or adoptive father includes a floor number.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 5. Physical Address. Check Suite | CheckBox |
Check this box if the physical address of your U.S. citizen biological or adoptive father includes a suite number.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 5. Physical Address. Check Apartment | CheckBox |
Check this box if the physical address of your U.S. citizen biological or adoptive father includes an apartment number.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 5. Physical Address. Enter Street Number and Name | Text |
Enter the street number and name of the physical address of your U.S. citizen biological or adoptive father.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 5. Physical Address. Enter Postal Code (foreign address only) | Text |
Enter the postal code of the physical address of your U.S. citizen biological or adoptive father if it is a foreign address.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 5. Physical Address. Enter Province or Region (foreign address only) | Text |
Enter the province or region of the physical address of your U.S. citizen biological or adoptive father if it is a foreign address.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 5. Physical Address. Enter Country (foreign address only) | Text |
Enter the country of the physical address of your U.S. citizen biological or adoptive father if it is a foreign address.
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| Father's Spouse Information | ||
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. G. Place of Marriage. Enter Date of Birth as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date of birth of your U.S. citizen father's current spouse. Use the format mm/dd/yyyy.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. I. Is your U.S. citizen father's current spouse also your biological (or adopted) mother? Check No | CheckBox |
Check this box if your U.S. citizen father's current spouse is not your biological or adopted mother.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. I. Is your U.S. citizen father's current spouse also your biological (or adopted) mother? Check Yes | CheckBox |
Check this box if your U.S. citizen father's current spouse is your biological or adopted mother.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. H. Spouse's Immigration Status. Check Other. Enter Explanation | Text |
Provide an explanation for the current spouse's immigration status if 'Other' is selected.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. H. Spouse's Immigration Status. Check Other | CheckBox |
Check this box if the current spouse's immigration status is 'Other'.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. D. Enter Country of Birth | Text |
Enter the country of birth of the U.S. citizen father's current spouse.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. E. Spouse's Physical Address. Enter Street Number and Name | Text |
Enter the street number and name of the physical address of the U.S. citizen father's current spouse.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. E. Spouse's Physical Address. If Apartment, Suite or Floor is Checked, Enter Apartment, Suite or Floor Number | Text |
If applicable, enter the apartment, suite, or floor number of the physical address of the U.S. citizen father's current spouse.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. E. Spouse's Physical Address. Check Floor | CheckBox |
Check this box if the physical address of the U.S. citizen father's current spouse includes a floor number.
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| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. E. Spouse's Physical Address. Check Suite | CheckBox |
Check this box if the physical address of the U.S. citizen father's current spouse includes a suite number.
|
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. E. Spouse's Physical Address. Check Apartment | CheckBox |
Check this box if the physical address of the U.S. citizen father's current spouse includes an apartment number.
|
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. E. Spouse's Physical Address. Zip Code Plus 4. Enter 5-digit Zip Code | Text |
Enter the 5-digit zip code of the physical address of the U.S. citizen father's current spouse.
|
| Father's Spouse Physical Address | ||
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. E. Spouse's Physical Address. Select State from a List of States | ComboBox |
Select the state from the provided list where the current spouse of your U.S. citizen biological or adoptive father resides.
MP
PA
FM
MH
MN
CO
ND
RI
NE
NM
FL
MS
OR
WA
MT
AA
AK
DE
VT
SC
IL
CA
MD
PR
UT
VI
NV
AS
AE
NH
PW
SD
WY
CT
KS
MA
MI
AR
VA
IA
ID
TN
KY
GU
AP
WV
GA
HI
NY
AL
IN
OK
WI
NJ
OH
TX
NC
DC
LA
ME
MO
AZ
|
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. E. Spouse's Physical Address. Enter City | Text |
Enter the city where the current spouse of your U.S. citizen biological or adoptive father resides.
|
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. E. Spouse's Physical Address. Zip Code Plus 4. Enter 4-digit Zip Code Extension | Text |
Enter the 4-digit extension of the ZIP code for the physical address of the current spouse of your U.S. citizen biological or adoptive father.
|
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. E. Spouse's Physical Address. Enter Postal Code (foreign address only) | Text |
Enter the postal code for the physical address of the current spouse of your U.S. citizen biological or adoptive father if the address is outside the United States.
|
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. E. Spouse's Physical Address. Enter Province or Region (foreign address only) | Text |
Enter the province or region for the physical address of the current spouse of your U.S. citizen biological or adoptive father if the address is outside the United States.
|
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. E. Spouse's Physical Address. Enter Country (foreign address only) | Text |
Enter the country for the physical address of the current spouse of your U.S. citizen biological or adoptive father if the address is outside the United States.
|
| Father's Spouse Place of Marriage | ||
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 9. Information About U.S. Citizen Father's Current Spouse. G. Place of Marriage. Enter Country | Text |
Enter the country where the marriage of your U.S. citizen biological or adoptive father and his current spouse took place.
|
| Form Identification | ||
| PDF417BarCode1 | Text |
This is a barcode field used for form identification and processing.
|
| PDF417BarCode1 | Text |
This is a barcode field used for form identification and processing.
|
| Form Metadata | ||
| PDF417BarCode1 | Text |
This is a PDF417 barcode that contains encoded information about the form.
|
| PDF417BarCode1 | Text |
This field contains a barcode that encodes specific information about the form, including its type and version.
|
| PDF417BarCode1 | Text |
This is a barcode field used for form identification and processing.
|
| PDF417BarCode1 | Text |
This is a barcode field that contains encoded information about the form. No input is required.
|
| PDF417BarCode1 | Text |
This is a barcode field that contains encoded information about the form. No input is required.
|
| PDF417BarCode1 | Text |
This is a barcode field that contains encoded information about the form. No entry is required.
|
| Form Processing | ||
| PDF417BarCode1 | Text |
This is a barcode field used for form processing. No input required.
|
| General Information | ||
| To be | CheckBox |
Check this box if applicable.
|
| Immigration Status | ||
| Part 2. Information About You. 14. Information About Your Admission into the United States and Current Immigration Status. B. I used the following travel document to be admitted to the United States. Check Travel Document | CheckBox |
Specify if you used a travel document to be admitted to the United States by checking this box.
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| Part 2. Information About You. 14. Information About Your Admission into the United States and Current Immigration Status. B. I used the following travel document to be admitted to the United States. Check Passport | CheckBox |
Specify if you used a passport to be admitted to the United States by checking this box.
|
| Part 2. Information About You. 14. Information About Your Admission into the United States and Current Immigration Status. B. I used the following travel document to be admitted to the United States. Enter Passport Number | Text |
Enter the passport number you used to be admitted to the United States. Maximum length is 30 characters.
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| Part 2. Information About You. 14. Information About Your Admission into the United States and Current Immigration Status. B. I used the following travel document to be admitted to the United States. Enter Travel Document | Text |
Enter the travel document number you used to be admitted to the United States. Maximum length is 30 characters.
|
| Part 2. Information About You. 14. Information About Your Admission into the United States and Current Immigration Status. B. I used the following travel document to be admitted to the United States. Enter Country of Issuance for Passport or Travel Document | Text |
Enter the country of issuance for the passport or travel document you used to be admitted to the United States.
|
| Part 2. Information About You. 14. Information About Your Admission into the United States and Current Immigration Status. B. I used the following travel document to be admitted to the United States. Enter Date Passport or Travel Document Issued (mm/dd/yyyy). Enter To Date as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date your passport or travel document was issued in the format MM/DD/YYYY.
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| Part 2. Information About You. 14. Information About Your Admission into the United States and Current Immigration Status. D. I am. Enter Date I became a LPR (mm/dd/yyyy). Enter Date as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date you became a Lawful Permanent Resident (LPR) in the format MM/DD/YYYY.
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| Part 2. Information About You. 14. Information About Your Admission into the United States and Current Immigration Status. D. I am. Enter U.S. Citizenship and Immigration Services (USCIS) Office That Granted My LPR Status or Location Where I Was Admitted | Text |
Enter the name of the U.S. Citizenship and Immigration Services (USCIS) office that granted your LPR status or the location where you were admitted.
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| Part 2. Information About You. 16. Have you ever abandoned or lost your LPR status? Check No | CheckBox |
Check this box if you have not abandoned or lost your LPR status.
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| Part 2. Information About You. 16. Have you ever abandoned or lost your LPR status? Check Yes | CheckBox |
Check this box if you have abandoned or lost your LPR status.
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| Part 2. Information About You (Provide information about yourself if you are a person applying for the Certificate of Citizenship. Provide information about your child if you are a U. S. citizen parent applying for a Certificate of Citizenship for your minor child.) 16. Information about admission into the United States and current immigration status. C. I am: If Other (explain) is Checked, Enter Explanation | Text |
Provide an explanation if you selected 'Other' for your current immigration status.
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| Part 2. Information About You. 16. Have you ever abandoned or lost your LPR status? If you answered "Yes" to Item Number 16., provide an explanation below. If you need extra space to complete this section, use the space provided in Part 11. Additional Information | Text |
Provide an explanation if you have ever abandoned or lost your Lawful Permanent Resident (LPR) status.
|
| Part 2. Information About You. 14. Information About Your Admission into the United States and Current Immigration Status. C. I am. Select A Lawful Permanent Resident (LPR) | CheckBox |
Select this checkbox if you are a Lawful Permanent Resident (LPR).
|
| Part 2. Information About You. 14. Information About Your Admission into the United States and Current Immigration Status. C. I am. Select A Nonimmigrant. A Refugee/Asylee | CheckBox |
Select this checkbox if you are a Nonimmigrant.
|
| Part 2. Information About You. 14. Information About Your Admission into the United States and Current Immigration Status. C. I am. Select Other (Explain) | CheckBox |
Select this checkbox if your status is 'Other' and provide an explanation.
|
| Part 2. Information About You. 14. Information About Your Admission into the United States and Current Immigration Status. C. I am. Select A Refugee/Asylee | CheckBox |
Select this checkbox if you are a Refugee or Asylee.
|
| Part 2. Information About You. 15. Information About Your Admission into the United States and Current Immigration Status. C. I am. Select Other (Explain). Enter Explanation | Text |
Provide an explanation if you selected 'Other' for your current immigration status.
|
| Internal Use | ||
| PDF417BarCode1 | Text |
This is a barcode field for internal use. No entry is required.
|
| PDF417BarCode1 | Text |
This is a barcode field for internal use.
|
| PDF417BarCode1 | Text |
This field contains a barcode for internal use. No entry is required.
|
| Interpreter Information | ||
| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Certification. I certify, under penalty of perjury, that: I am fluent in English and BLANK LANGUAGE , which is the same language specified in Part 8., 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 Certification, and has verified the accuracy of every answer. Enter fluent language | Text |
Enter the language in which you are fluent and have used to interpret the application for the applicant. This should be the same language specified in Part 8, Item B.
|
| Part 9. Interpreter's Contact Information, Certification, and Signature. 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 the signature cannot be electronic or typewritten.
|
| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Signature. Date of Signature. Enter the 2 digit month, 2 digit day and 4 digit year | Text |
Enter the date when the interpreter signed the form. Use the format MM/DD/YYYY.
|
| Interpreter's Contact Information | ||
| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Contact Information. 4. Enter Interpreter's Email Address (if any) | Text |
Enter the interpreter's email address, if available.
|
| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Contact Information. 4. Enter Interpreter's Daytime Telephone Number | Text |
Enter the interpreter's daytime telephone number.
|
| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Contact Information. 5. Enter Interpreter's Mobile Telephone Number (if any) | Text |
Enter the interpreter's mobile telephone number, if available.
|
| Interpreter's Information | ||
| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Full Name. 1. Interpreter's Business or Organization Name (if any) | Text |
Enter the business or organization name of the interpreter, if applicable.
|
| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Full Name. 1. Interpreter's Given Name (First Name) | Text |
Enter the given name (first name) of the interpreter.
|
| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Full Name. 1. Interpreter's Family Name (Last Name) | Text |
Enter the family name (last name) of the interpreter.
|
| Interpreter's Mailing Address | ||
| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. Enter the City or Town | Text |
Enter the city or town of the interpreter's mailing address.
|
| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. Enter Province or Region (foreign address only) | Text |
Enter the province or region of the interpreter's mailing address (for foreign addresses only).
|
| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. Enter Postal Code | Text |
Enter the postal code of the interpreter's mailing address.
|
| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. Enter the state. You will be making a selection from a drop down box containing 2 letter abbreviations of state names | ComboBox |
Select the state of the interpreter's mailing address from the dropdown list.
MP
PA
FM
MH
MN
CO
ND
RI
NE
NM
FL
MS
OR
WA
MT
AA
AK
DE
VT
SC
IL
CA
MD
PR
UT
VI
NV
AS
AE
NH
PW
SD
WY
CT
KS
MA
MI
AR
VA
IA
ID
TN
KY
GU
AP
WV
GA
HI
NY
AL
IN
OK
WI
NJ
OH
TX
NC
DC
LA
ME
MO
AZ
|
| Part 9. Interpreter's Contact Information, Certification, and Signature. 3. Interpreter's Mailing Address. Enter Street Number and Name | Text |
Enter the street number and name of the interpreter's mailing address.
|
| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. Check Suite | CheckBox |
Check this box if the interpreter's mailing address includes a suite.
|
| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. Check Floor | CheckBox |
Check this box if the interpreter's mailing address includes a floor.
|
| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. If Apartment, Suite or Floor is Checked, Enter Apartment, Suite or Floor Number | Text |
If you checked 'Apartment', 'Suite', or 'Floor', enter the corresponding number here.
|
| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. Check Apartment | CheckBox |
Check this box if the interpreter's mailing address includes an apartment.
|
| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. Enter Country | Text |
Enter the country of the interpreter's mailing address.
|
| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. Zip Code Plus 4. Enter 5-digit Zip Code | Text |
Enter the 5-digit ZIP code of the interpreter's mailing address.
|
| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. Zip Code Plus 4. Enter 4-digit Zip Code Extension | Text |
Enter the 4-digit ZIP code extension of the interpreter's mailing address.
|
| Mailing Address | ||
| Part 2. Information About You. 10 Mailing Address. Enter C/O ("In Care Of" Name, if applicable) | Text |
Enter the 'In Care Of' name for your mailing address, if applicable.
|
| Part 2. Information About You. 10. Mailing Address. If Apartment, Suite or Floor is Checked, Enter Apartment, Suite or Floor Number | Text |
If applicable, enter the apartment, suite, or floor number of your mailing address.
|
| Part 2. Information About You. 10. Mailing Address. Check Floor | CheckBox |
Check this box if your mailing address includes a floor number.
|
| Part 2. Information About You. 10. Check Suite | CheckBox |
Check this box if your mailing address includes a suite number.
|
| Part 2. Information About You. 10. Check Apartment | CheckBox |
Check this box if your mailing address includes an apartment number.
|
| Part 2. Information About You. 10 Mailing Address (if different from the address above). Enter C/O ("In Care Of" Name, if applicable). Enter Street Number and Name | Text |
Enter the 'In Care Of' name, if applicable, and the street number and name of your mailing address if it is different from the address above.
|
| Part 2. Information About You. 10. Mailing Address. Enter Postal Code (foreign address only) | Text |
Enter the postal code for your foreign mailing address, if applicable.
|
| Part 2. Information About You. 10. Mailing Address. Enter Province or Region (foreign address only) | Text |
Enter the province or region for your foreign mailing address, if applicable.
|
| Part 2. Information About You. 10. Mailing Address. Enter Country (foreign address only) | Text |
Enter the country for your foreign mailing address, if applicable.
|
| Marital History | ||
| Part 9. Information About Your Marital History. 7. If your current spouse is not a U. S. citizen, complete the following information. C. Current Spouse's Immigration Status. Check U S Citizen | CheckBox |
Indicate if your current spouse is a U.S. citizen by checking this box.
|
| Marital Status | ||
| Part 2. Information About You. 12. Current Marital Status. Check Divorced | CheckBox |
Check this box if your current marital status is divorced.
|
| Part 2. Information About You. 12. Current Marital Status. Check Single, never married | CheckBox |
Check this box if your current marital status is single and never married.
|
| Part 2. Information About You. 12. Current Marital Status. Check Widowed | CheckBox |
Check this box if your current marital status is widowed.
|
| Part 2. Information About You. 12. Current Marital Status. Check Married | CheckBox |
Check this box if your current marital status is married.
|
| Part 2. Information About You. 12. Current Marital Status. Check Separated | CheckBox |
Check this box if your current marital status is separated.
|
| Part 2. Information About You. 12. Current Marital Status.Check Married | CheckBox |
Check this box if your current marital status is married.
|
| Part 2. Information About You. 12. Current Marital Status. Check Marriage Annulled | CheckBox |
Check this box if your current marital status is marriage annulled.
|
| Military Service | ||
| Part 2. Information About You. 13. U.S. Armed Forces. Are you a member or veteran of any branch of the U.S. Armed Forces? Check No | CheckBox |
Indicate whether you are currently a member or a veteran of any branch of the U.S. Armed Forces by checking 'No'.
|
| Part 2. Information About You. 13. U.S. Armed Forces. Are you a member or veteran of any branch of the U.S. Armed Forces? Check Yes | CheckBox |
Indicate whether you are currently a member or a veteran of any branch of the U.S. Armed Forces by checking 'Yes'.
|
| Military Service Information | ||
| Part 7. Information About Your Military Service of U.S. Citizen Parents. NOTE: Complete this only if you are an applicant claiming U.S. citizenship at time of birth abroad. 1. Has your U.S. citizen parent served in the U.S. Armed Forces? Check No | CheckBox |
Indicate whether your U.S. citizen parent has served in the U.S. Armed Forces by checking 'No'. Complete this section only if you are claiming U.S. citizenship at birth abroad.
|
| Part 7. Information About Your Military Service of U.S. Citizen Parents. NOTE: Complete this only if you are an applicant claiming U.S. citizenship at time of birth abroad. 1. Has your U.S. citizen parent served in the U.S. Armed Forces? Check Yes | CheckBox |
Indicate whether your U.S. citizen parent has served in the U.S. Armed Forces by checking 'Yes'. Complete this section only if you are claiming U.S. citizenship at birth abroad.
|
| Part 7. Information About Your Military Service of U.S. Citizen Parents. 2. If you answered "Yes" to Item Number 1., which parent served in the U.S. Armed Forces? Check U.S. Citizen Father | CheckBox |
If you answered 'Yes' to the question about your U.S. citizen parent's military service, check this box to indicate that your U.S. citizen father served in the U.S. Armed Forces.
|
| Part 7. Information About Your Military Service of U.S. Citizen Parents. 2. If you answered "Yes" to Item Number 1., which parent served in the U.S. Armed Forces? Check U.S. Citizen Mother | CheckBox |
If you answered 'Yes' to the question about your U.S. citizen parent's military service, check this box to indicate that your U.S. citizen mother served in the U.S. Armed Forces.
|
| Part 7. Information About Military Service of U.S. Citizen Parents. 4. Type of Discharge. Check Other than Honorable | CheckBox |
If your U.S. citizen parent served in the U.S. Armed Forces, check this box to indicate that their type of discharge was 'Other than Honorable'.
|
| Part 7. Information About Military Service of U.S. Citizen Parents. 4. Type of Discharge. Check Honorable | CheckBox |
If your U.S. citizen parent served in the U.S. Armed Forces, check this box to indicate that their type of discharge was 'Honorable'.
|
| Part 7. Information About Military Service of U.S. Citizen Parents. 4. Type of Discharge. Check Dishonorable | CheckBox |
If your U.S. citizen parent served in the U.S. Armed Forces, check this box to indicate that their type of discharge was 'Dishonorable'.
|
| Part 7. Information About Military Service of U.S. Citizen Parents. 3. Dates of Service (mm/dd/yyyy) (if time of service fulfills any of the required physical presence, submit evidence of the service). A. Enter To (mm/dd/yyyy). Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the end date of the U.S. citizen parent's military service in the format MM/DD/YYYY. This information is required if the service period is used to fulfill any physical presence requirements.
|
| Part 7. Information About Military Service of U.S. Citizen Parents. 3. Dates of Service (mm/dd/yyyy) (if time of service fulfills any of the required physical presence, submit evidence of the service). A. Enter From (mm/dd/yyyy). Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the start date of the U.S. citizen parent's military service in the format MM/DD/YYYY. This information is required if the service period is used to fulfill any physical presence requirements.
|
| Part 7. Information About Military Service of U.S. Citizen Parents. 3. Dates of Service (mm/dd/yyyy) (if time of service fulfills any of the required physical presence, submit evidence of the service). B. Enter From (mm/dd/yyyy). Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the start date of the U.S. citizen parent's military service in the format MM/DD/YYYY. This information is required if the service period is used to fulfill any physical presence requirements.
|
| Part 7. Information About Military Service of U.S. Citizen Parents. 3. Dates of Service (mm/dd/yyyy) (if time of service fulfills any of the required physical presence, submit evidence of the service). B. Enter From (mm/dd/yyyy). Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the start date of the U.S. citizen parent's military service in the format MM/DD/YYYY. This information is required if the service period is used to fulfill any physical presence requirements.
|
| Mother's Citizenship Information | ||
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 7. Has your mother ever lost U.S. citizenship or taken any action that would cause loss of U.S. citizenship?Check No | CheckBox |
Indicate whether your U.S. citizen biological or adoptive mother has ever lost U.S. citizenship or taken any action that would cause the loss of U.S. citizenship. Check 'No' if she has not.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 7. Has your mother ever lost U.S. citizenship or taken any action that would cause loss of U.S. citizenship?Check Yes. If you answered “Yes” to Item Number 7., provide an explanation in Part 11. Additional Information | CheckBox |
Indicate whether your U.S. citizen biological or adoptive mother has ever lost U.S. citizenship or taken any action that would cause the loss of U.S. citizenship. Check 'Yes' if she has, and provide an explanation in Part 11. Additional Information.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 6. My mother is a U.S. citizen by. Check Naturalization | CheckBox |
Check this box if your mother is a U.S. citizen by naturalization.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 6. My mother is a U.S. citizen by. Check Naturalization. Enter Alien Registration Number | Text |
Enter your mother's Alien Registration Number if she is a U.S. citizen by naturalization.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 6. My mother is a U.S. citizen by. Check Naturalization. Enter Certificate of Naturalization Number | Text |
Enter your mother's Certificate of Naturalization Number if she is a U.S. citizen by naturalization.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 6. My mother is a U.S. citizen by. Check Birth abroad to U. S. citizen parent or parents | CheckBox |
Check this box if your mother is a U.S. citizen by birth abroad to U.S. citizen parent or parents.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 6. My mother is a U.S. citizen by. Check Acquisition after birth through naturalization of alien parents | CheckBox |
Check this box if your mother is a U.S. citizen by acquisition after birth through the naturalization of alien parents.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 6. My mother is a U.S. citizen by. Check Birth in the United States | CheckBox |
Check this box if your mother is a U.S. citizen by birth in the United States.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 6. My mother is a U.S. citizen by. Check Birth abroad to U.S. citizen parents. Enter Alien Registration Number | Text |
Enter your mother's Alien Registration Number if she is a U.S. citizen by birth abroad to U.S. citizen parents.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 6. My mother is a U.S. citizen by. Check Birth abroad to U.S. citizen parents. Enter Certificate of Citizenship Number | Text |
Enter your mother's Certificate of Citizenship Number if she is a U.S. citizen by birth abroad to U.S. citizen parents.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 6. My mother is a U.S. citizen by. Check Naturalization. Enter City or Town. Select State from a List of States | ComboBox |
Select the state where your U.S. citizen biological or adoptive mother was naturalized.
MP
PA
FM
MH
MN
CO
ND
RI
NE
NM
FL
MS
OR
WA
MT
AA
AK
DE
VT
SC
IL
CA
MD
PR
UT
VI
NV
AS
AE
NH
PW
SD
WY
CT
KS
MA
MI
AR
VA
IA
ID
TN
KY
GU
AP
WV
GA
HI
NY
AL
IN
OK
WI
NJ
OH
TX
NC
DC
LA
ME
MO
AZ
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 6. My mother is a U.S. citizen by. Check Naturalization. Enter City or Town | Text |
Enter the city or town where your U.S. citizen biological or adoptive mother was naturalized.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 6. My mother is a U.S. citizen by. Check Naturalization. Enter Date of Naturalization | Text |
Enter the date when your U.S. citizen biological or adoptive mother was naturalized.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 6. My mother is a U.S. citizen by. Check Naturalization. Enter Place of Naturalization (Name of Court or USCIS Office Location) | Text |
Enter the place of naturalization (name of court or USCIS office location) where your U.S. citizen biological or adoptive mother was naturalized.
|
| Mother's Current Spouse Information | ||
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 9. Information About U.S. Citizen Mother's Current Spouse. A. Enter Mother's Middle Name, if applicable | Text |
Enter the middle name of your U.S. citizen mother's current spouse, if applicable.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 9. Information About U.S. Citizen Mother's Current Spouse. A. Enter Mother's Given Name (First Name) | Text |
Enter the given name (first name) of your U.S. citizen mother's current spouse.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 9. Information About U.S. Citizen Mother's Current Spouse. A. Enter Mother's Family Name (Last Name) | Text |
Enter the family name (last name) of your U.S. citizen mother's current spouse.
|
| Mother's Information | ||
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother) 1.Current Legal Name of U.S. Citizen Mother. Enter Middle Name | Text |
Enter the middle name of your U.S. citizen biological or adoptive mother.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother) 1.Current Legal Name of U.S. Citizen Mother. Given Name (First Name) | Text |
Enter the given (first) name of your U.S. citizen biological or adoptive mother.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother) 1.Current Legal Name of U.S. Citizen Mother. Family Name (Last Name) | Text |
Enter the family (last) name of your U.S. citizen biological or adoptive mother.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother) 1.Current Legal Name of U.S. Citizen Mother. 2. Enter Date of Birth (mm/dd/yyyy) | Text |
Enter the date of birth of your U.S. citizen biological or adoptive mother in the format mm/dd/yyyy.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother) 1.Current Legal Name of U.S. Citizen Mother. 3. Enter Country of Birth | Text |
Enter the country of birth of your U.S. citizen biological or adoptive mother.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother) 1.Current Legal Name of U.S. Citizen Mother. 4. Enter Country of Birth | Text |
Enter the country of birth of your U.S. citizen biological or adoptive mother.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or adoptive mother). I. Is your U.S. citizen mother's current spouse also your biological (or adopted) father? Check Yes | CheckBox |
Indicate whether your U.S. citizen mother's current spouse is also your biological or adopted father by checking 'Yes'.
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| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 9. Information About U.S. Citizen Mother's Current Spouse. H. Spouse's Immigration Status. Check Lawful Permanent Resident | CheckBox |
Check this box if your U.S. citizen mother's current spouse is a Lawful Permanent Resident.
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| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 9. Information About U.S. Citizen Mother's Current Spouse. H. Spouse's Immigration Status. Check U S Citizen | CheckBox |
Check this box if your U.S. citizen mother's current spouse is a U.S. Citizen.
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| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 9. Information About U.S. Citizen Mother's Current Spouse. H. Spouse's Immigration Status. Check Other (explain). If you selected “Other,” provide an explanation. If you need extra space to complete this section, use the space provided in Part 11. Additional Information | CheckBox |
Check this box if your U.S. citizen mother's current spouse has an immigration status other than U.S. Citizen or Lawful Permanent Resident. Provide an explanation if you select 'Other'.
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| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 9. Information About U.S. Citizen Mother's Current Spouse. E. Spouse's Physical Address. Enter Mother's Date of Birth as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date of birth of your U.S. citizen mother's current spouse in the format MM/DD/YYYY.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 9. Information About U.S. Citizen Mother's Current Spouse. E. Spouse's Physical Address. Enter Street Number and Name | Text |
Enter the street number and name of the physical address of your U.S. citizen mother's current spouse. Maximum length is 34 characters.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 9. Information About U.S. Citizen Mother's Current Spouse. D. Enter Mother's Country of Birth | Text |
Enter the country where your U.S. citizen mother was born.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 9. Information About U.S. Citizen Mother's Current Spouse. G. Place of Marriage. Enter Country | Text |
Enter the country where your U.S. citizen biological or adoptive mother was married to her current spouse.
|
| Mother's Marital History | ||
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 8. Marital History. A. How many times has your U.S. citizen mother been married (including annulled marriages and marriages to the same person)? Enter Number of Marriages | Text |
Enter the total number of times your U.S. citizen mother has been married, including annulled marriages and marriages to the same person.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 8. Marital History. B. What is your U.S. citizen mother's current marital status? Check Other. Enter Explanation | Text |
If your U.S. citizen mother's current marital status is 'Other,' provide an explanation here.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 8. Marital History. B. What is your U.S. citizen mother's current marital status? Check Married. If you selected “Other,” provide an explanation. If you need extra space to complete this section, use the space provided in Part 11. Additional Information | CheckBox |
Check this box if your U.S. citizen mother's current marital status is 'Married.' If you selected 'Other,' provide an explanation in the designated text field.
|
| Mother's Marital Status | ||
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 8. Marital History. B. What is your U.S. citizen mother's current marital status? Check Divorced | CheckBox |
Select 'Divorced' to indicate that your U.S. citizen mother is currently divorced.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 8. Marital History. B. What is your U.S. citizen mother's current marital status? Check Single, never married | CheckBox |
Select 'Single, never married' to indicate that your U.S. citizen mother has never been married.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 8. Marital History. B. What is your U.S. citizen mother's current marital status? Check Widowed | CheckBox |
Select 'Widowed' to indicate that your U.S. citizen mother is currently widowed.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 8. Marital History. B. What is your U.S. citizen mother's current marital status? Check Married | CheckBox |
Select 'Married' to indicate that your U.S. citizen mother is currently married.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 8. Marital History. B. What is your U.S. citizen mother's current marital status? Check Marriage Annulled | CheckBox |
Select 'Marriage Annulled' to indicate that your U.S. citizen mother's marriage has been annulled.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 8. Marital History. B. What is your U.S. citizen mother's current marital status? Check Separated | CheckBox |
Select 'Separated' to indicate that your U.S. citizen mother is currently separated from her spouse.
|
| Mother's Physical Address | ||
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 5. Physical Address. Enter City | Text |
Enter the city of your mother's physical address.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 5. Physical Address. Select State from a List of States | ComboBox |
Select the state of your mother's physical address from the list of states.
MP
PA
FM
MH
MN
CO
ND
RI
NE
NM
FL
MS
OR
WA
MT
AA
AK
DE
VT
SC
IL
CA
MD
PR
UT
VI
NV
AS
AE
NH
PW
SD
WY
CT
KS
MA
MI
AR
VA
IA
ID
TN
KY
GU
AP
WV
GA
HI
NY
AL
IN
OK
WI
NJ
OH
TX
NC
DC
LA
ME
MO
AZ
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 5. Physical Address. Zip Code Plus 4. Enter 5-digit Zip Code | Text |
Enter the 5-digit zip code of your mother's physical address.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 5. Physical Address. Zip Code Plus 4. Enter 4-digit Zip Code Extension | Text |
Enter the 4-digit extension of the ZIP code for the physical address of your U.S. citizen biological or adoptive mother.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 5. Physical Address. If Apartment, Suite or Floor is Checked, Enter Apartment, Suite or Floor Number | Text |
If applicable, enter the apartment, suite, or floor number for the physical address of your U.S. citizen biological or adoptive mother.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 5. Physical Address. Check Floor | CheckBox |
Check this box if the physical address of your U.S. citizen biological or adoptive mother includes a floor number.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 5. Physical Address. Check Suite | CheckBox |
Check this box if the physical address of your U.S. citizen biological or adoptive mother includes a suite number.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 5. Physical Address. Check Apartment | CheckBox |
Check this box if the physical address of your U.S. citizen biological or adoptive mother includes an apartment number.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 5. Physical Address. Enter Street Number and Name (Type or print "Deceased" and the date of death if your mother has passed away.) | Text |
Enter the street number and name for the physical address of your U.S. citizen biological or adoptive mother. If your mother is deceased, type or print 'Deceased' and the date of death.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 5. Physical Address. Enter Postal Code (foreign address only) | Text |
Enter the postal code for the physical address of your U.S. citizen biological or adoptive mother if it is a foreign address.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 5. Physical Address. Enter Province or Region (foreign address only) | Text |
Enter the province or region for the physical address of your U.S. citizen biological or adoptive mother if it is a foreign address.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 5. Physical Address. Enter Country (foreign address only) | Text |
Enter the country for the physical address of your U.S. citizen biological or adoptive mother if it is a foreign address.
|
| Mother's Spouse Address | ||
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 9. Information About U.S. Citizen Mother's Current Spouse. E. Spouse's Physical Address. If Apartment, Suite or Floor is Checked, Enter Apartment, Suite or Floor Number | Text |
Enter the apartment, suite, or floor number of the current physical address of your U.S. citizen mother's current spouse, if applicable.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 9. Information About U.S. Citizen Mother's Current Spouse. E. Spouse's Physical Address. Check Floor | CheckBox |
Check this box if the physical address of your U.S. citizen mother's current spouse includes a floor number.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 9. Information About U.S. Citizen Mother's Current Spouse. E. Spouse's Physical Address. Check Suite | CheckBox |
Check this box if the physical address of your U.S. citizen mother's current spouse includes a suite number.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 9. Information About U.S. Citizen Mother's Current Spouse. E. Spouse's Physical Address. Check Apartment | CheckBox |
Check this box if the physical address of your U.S. citizen mother's current spouse includes an apartment number.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 9. Information About U.S. Citizen Mother's Current Spouse. E. Spouse's Physical Address. Zip Code Plus 4. Enter 5-digit Zip Code | Text |
Enter the 5-digit ZIP code of the current physical address of your U.S. citizen mother's current spouse.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 9. Information About U.S. Citizen Mother's Current Spouse. E. Spouse's Physical Address. Select State from a List of States | ComboBox |
Select the state from the provided list for the current physical address of your U.S. citizen mother's current spouse.
MP
PA
FM
MH
MN
CO
ND
RI
NE
NM
FL
MS
OR
WA
MT
AA
AK
DE
VT
SC
IL
CA
MD
PR
UT
VI
NV
AS
AE
NH
PW
SD
WY
CT
KS
MA
MI
AR
VA
IA
ID
TN
KY
GU
AP
WV
GA
HI
NY
AL
IN
OK
WI
NJ
OH
TX
NC
DC
LA
ME
MO
AZ
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 9. Information About U.S. Citizen Mother's Current Spouse. E. Spouse's Physical Address. Enter City or Town | Text |
Enter the city or town of the current physical address of your U.S. citizen mother's current spouse.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 9. Information About U.S. Citizen Mother's Current Spouse. E. Spouse's Physical Address. Zip Code Plus 4. Enter 4-digit Zip Code Extension | Text |
Enter the 4-digit extension of the ZIP code for the physical address of your U.S. citizen mother's current spouse.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 9. Information About U.S. Citizen Mother's Current Spouse. E. Spouse's Physical Address. Enter Postal Code (foreign address only) | Text |
Enter the postal code for the physical address of your U.S. citizen mother's current spouse if the address is outside the United States.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 9. Information About U.S. Citizen Mother's Current Spouse. E. Spouse's Physical Address. Enter Province or Region (foreign address only) | Text |
Enter the province or region for the physical address of your U.S. citizen mother's current spouse if the address is outside the United States.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 9. Information About U.S. Citizen Mother's Current Spouse. E. Spouse's Physical Address. Enter Country (foreign address only) | Text |
Enter the country for the physical address of your U.S. citizen mother's current spouse if the address is outside the United States.
|
| Mother's Spouse Information | ||
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 9. Information About U.S. Citizen Mother's Current Spouse. B. Enter Mother's Date of Birth as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date of birth of your U.S. citizen mother's current spouse in the format MM/DD/YYYY.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 9. Information About U.S. Citizen Mother's Current Spouse. C. Enter Mother's Country of Birth | Text |
Enter the country of birth of your U.S. citizen mother's current spouse.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or adoptive mother). I. Is your U.S. citizen mother's current spouse also your biological (or adopted) father? Check No | CheckBox |
Check this box if your U.S. citizen mother's current spouse is not your biological or adopted father.
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 9. Information About U.S. Citizen Mother's Current Spouse. G. Place of Marriage. Select State from a List of States | ComboBox |
Select the state from the list where your U.S. citizen mother and her current spouse were married.
MP
PA
FM
MH
MN
CO
ND
RI
NE
NM
FL
MS
OR
WA
MT
AA
AK
DE
VT
SC
IL
CA
MD
PR
UT
VI
NV
AS
AE
NH
PW
SD
WY
CT
KS
MA
MI
AR
VA
IA
ID
TN
KY
GU
AP
WV
GA
HI
NY
AL
IN
OK
WI
NJ
OH
TX
NC
DC
LA
ME
MO
AZ
|
| Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother). 9. Information About U.S. Citizen Mother's Current Spouse. G. Place of Marriage. Enter City or Town | Text |
Enter the city or town where your U.S. citizen mother and her current spouse were married.
|
| Officer Report | ||
| Part 13. Officer Report and Recommendation on Application for Certificate of Citizenship (for USCIS use ONLY) On the basis of the documents, records, the testimony of persons examined, and the identification upon personal appearance of the underage beneficiary, I find that all the facts and conclusions set forth under oath in this application are: 1. Check True and Correct | CheckBox |
This checkbox is for the USCIS officer to indicate that the facts and conclusions set forth under oath in the application are true and correct. No entry is required from the applicant.
|
| Parent Information | ||
| Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father). 5. Physical Address. If Apartment, Suite or Floor is Checked, Enter Apartment, Suite or Floor Number | Text |
If applicable, enter the apartment, suite, or floor number for the physical address of your U.S. citizen biological or adoptive father.
|
| Parental Marital Status | ||
| Part 2. Information About You. 18. Did you have to be re-adopted in the United States? 19. Were your parents married to each other when you were born (or adopted)? Select No | CheckBox |
Select 'No' if your parents were not married to each other when you were born or adopted.
|
| Part 2. Information About You. 18. Did you have to be re-adopted in the United States? 19. Were your parents married to each other when you were born (or adopted)? Select Yes | CheckBox |
Select 'Yes' if your parents were married to each other when you were born or adopted.
|
| Part 2. Information About You. 18. Did you have to be re-adopted in the United States? 20. Did your parents marry after you were born? Select No | CheckBox |
Select 'No' if your parents did not marry after you were born.
|
| Part 2. Information About You. 18. Did you have to be re-adopted in the United States? 20. Did your parents marry after you were born? Select Yes | CheckBox |
Select 'Yes' if your parents married after you were born.
|
| Personal Information | ||
| Part 2. Information About You. 1.Current Legal Name (do not provide a nickname) Middle Name | Text |
Enter your current legal middle name. Do not provide a nickname.
|
| Part 2. Information About You. 1.Current Legal Name (do not provide a nickname) Given Name (First Name) | Text |
Enter your current legal first name. Do not provide a nickname.
|
| Part 2. Information About You. 1.Current Legal Name (do not provide a nickname)Family Name (Last Name) | Text |
Enter your current legal last name. Do not provide a nickname.
|
| Part 2. Information About You. 2. Your Name Exactly As It Appears on Your Permanent Resident Card (if different from above). Family Name (Last Name) | Text |
Enter your last name exactly as it appears on your Permanent Resident Card, if it is different from your current legal last name.
|
| Part 2. Information About You. 2. Name Exactly As It Appears on Your Permanent Resident Card (if applicable). Given Name (First Name) | Text |
Enter your first name exactly as it appears on your Permanent Resident Card, if it is different from your current legal first name.
|
| Part 2. Information About You. 2. Name Exactly As It Appears on Your Permanent Resident Card (if applicable). Middle Name | Text |
Enter your middle name exactly as it appears on your Permanent Resident Card, if it is different from your current legal middle name.
|
| Page 3. Alien Registration Number (A-Number). No Entry | Text |
Enter your Alien Registration Number (A-Number). Maximum length is 9 characters.
|
| Page 4. Alien Registration Number (A-Number). No Entry | Text |
Enter your Alien Registration Number (A-Number), which is a unique 9-digit number assigned to non-citizens by the Department of Homeland Security.
|
| Page 8. Alien Registration Number (A-Number). No Entry | Text |
Enter your Alien Registration Number (A-Number), which is a unique 9-digit number assigned to non-citizens by the Department of Homeland Security.
|
| Part 11. Additional Information. If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Include your name and. A. Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet. 1. Enter Family Name (Last Name) | Text |
Enter your family name (last name) as it appears on official documents. This field has a maximum length of 30 characters.
|
| Part 11. Additional Information. If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Include your name and. A. Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet. 1. Enter Given Name (First Name) | Text |
Enter your given name (first name) as it appears on official documents. This field has a maximum length of 18 characters.
|
| Part 11. Additional Information. If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Include your name and. A. Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet. 1. Enter Middle Name | Text |
Enter your middle name as it appears on official documents. This field has a maximum length of 18 characters.
|
| Page 2. Alien Registration Number (A-Number). No Entry | Text |
Enter your Alien Registration Number (A-Number) if you have one. This number is issued by the U.S. Citizenship and Immigration Services (USCIS) and is used to identify non-citizens.
|
| Page 2. Alien Registration Number (A-Number). No Entry | Text |
Enter your Alien Registration Number (A-Number). This number is typically 9 digits long.
|
| Physical Address | ||
| Part 2. Information About You. 11. Physical Address. Select State from a List of States | ComboBox |
Select the state where your physical address is located from the provided list of states.
MP
PA
FM
MH
MN
CO
ND
RI
NE
NM
FL
MS
OR
WA
MT
AA
AK
DE
VT
SC
IL
CA
MD
PR
UT
VI
NV
AS
AE
NH
PW
SD
WY
CT
KS
MA
MI
AR
VA
IA
ID
TN
KY
GU
AP
WV
GA
HI
NY
AL
IN
OK
WI
NJ
OH
TX
NC
DC
LA
ME
MO
AZ
|
| Part 2. Information About You. 11. Physical Address. Zip Code Plus 4. Enter 5-digit Zip Code | Text |
Enter the 5-digit ZIP code for your physical address.
|
| Part 2. Information About You. 11. Physical Address. Zip Code Plus 4. Enter 4-digit Zip Code Extension | Text |
Enter the 4-digit ZIP code extension for your physical address.
|
| Part 2. Information About You. 11. Physical Address. If Apartment, Suite or Floor is Checked, Enter Apartment, Suite or Floor Number | Text |
If applicable, enter the apartment, suite, or floor number for your physical address.
|
| Part 2. Information About You. 11. Physical Address. Check Floor | CheckBox |
Check this box if your physical address includes a floor number.
|
| Part 2. Information About You. 11. Physical Address. Check Suite | CheckBox |
Check this box if your physical address includes a suite number.
|
| Part 2. Information About You. 11. Physical Address. Check Apartment | CheckBox |
Check this box if your physical address includes an apartment number.
|
| Part 2. Information About You. 11. Physical Address. Enter Street Number and Name | Text |
Enter the street number and name for your physical address.
|
| Part 2. Information About You. 11. Physical Address. Enter Postal Code (foreign address only) | Text |
If you have a foreign address, enter the postal code here.
|
| Part 2. Information About You. 11. Physical Address. Enter Province or Region (foreign address only) | Text |
Enter the province or region of your physical address if it is a foreign address.
|
| Part 2. Information About You. 11. Physical Address. Enter Country (foreign address only) | Text |
Enter the country of your physical address if it is a foreign address.
|
| Physical Presence | ||
| Part 6. Physical Presence in the United States From Birth Until Filing of Form N-600. 1. Indicate whether this information relates to your U.S. citizen father or mother. Check U.S. Citizen Father | CheckBox |
Check this box if the information about physical presence in the United States relates to your U.S. citizen father.
|
| Part 6. Physical Presence in the United States From Birth Until Filing of Form N-600. 1. Indicate whether this information relates to your U.S. citizen father or mother. Check U.S. Citizen Mother | CheckBox |
Check this box if the information about physical presence in the United States relates to your U.S. citizen mother.
|
| Part 6. Physical Presence in the United States From Birth Until Filing of Form N-600. 2. Physical Presence in the United States. A. Enter From (mm/dd/yyyy). Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the start date of your physical presence in the United States in the format MM/DD/YYYY.
|
| Part 6. Physical Presence in the United States From Birth Until Filing of Form N-600. 2. Physical Presence in the United States. A. Enter To (mm/dd/yyyy). Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the end date of your physical presence in the United States for the first period. Use the format MM/DD/YYYY.
|
| Part 6. Physical Presence in the United States From Birth Until Filing of Form N-600. 2. Physical Presence in the United States. B. Enter From (mm/dd/yyyy). Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the start date of your physical presence in the United States for the second period. Use the format MM/DD/YYYY.
|
| Part 6. Physical Presence in the United States From Birth Until Filing of Form N-600. 2. Physical Presence in the United States. B. Enter To (mm/dd/yyyy). Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the end date of your physical presence in the United States for the second period. Use the format MM/DD/YYYY.
|
| Part 6. Physical Presence in the United States From Birth Until Filing of Form N-600. 2. Physical Presence in the United States. C. Enter From (mm/dd/yyyy). Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the start date of your physical presence in the United States for the third period. Use the format MM/DD/YYYY.
|
| Part 6. Physical Presence in the United States From Birth Until Filing of Form N-600. 2. Physical Presence in the United States. C. Enter To (mm/dd/yyyy). Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the end date of your physical presence in the United States for the third period. Use the format MM/DD/YYYY.
|
| Part 6. Physical Presence in the United States From Birth Until Filing of Form N-600. 2. Physical Presence in the United States. D. Enter From (mm/dd/yyyy). Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the start date of your physical presence in the United States for the fourth period. Use the format MM/DD/YYYY.
|
| Part 6. Physical Presence in the United States From Birth Until Filing of Form N-600. 2. Physical Presence in the United States. D. Enter To (mm/dd/yyyy). Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the end date of your physical presence in the United States for the fourth period. Use the format MM/DD/YYYY.
|
| Part 6. Physical Presence in the United States From Birth Until Filing of Form N-600. 2. Physical Presence in the United States. E. Enter From (mm/dd/yyyy). Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the start date of your physical presence in the United States for the fifth period. Use the format MM/DD/YYYY.
|
| Part 6. Physical Presence in the United States From Birth Until Filing of Form N-600. 2. Physical Presence in the United States. E. Enter To (mm/dd/yyyy). Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the end date of your physical presence in the United States for the fifth period. Use the format MM/DD/YYYY.
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| Part 6. Physical Presence in the United States From Birth Until Filing of Form N-600. 2. Physical Presence in the United States. F. Enter From (mm/dd/yyyy). Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the start date of your physical presence in the United States in the format MM/DD/YYYY.
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| Part 6. Physical Presence in the United States From Birth Until Filing of Form N-600. 2. Physical Presence in the United States. F. Enter To (mm/dd/yyyy). Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the end date of your physical presence in the United States in the format MM/DD/YYYY.
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| Part 6. Physical Presence in the United States From Birth Until Filing of Form N-600. 2. Physical Presence in the United States. G. Enter From (mm/dd/yyyy). Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the start date of another period of your physical presence in the United States in the format MM/DD/YYYY.
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| Part 6. Physical Presence in the United States From Birth Until Filing of Form N-600. 2. Physical Presence in the United States. G. Enter To (mm/dd/yyyy). Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the end date of another period of your physical presence in the United States in the format MM/DD/YYYY.
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| Part 6. Physical Presence in the United States From Birth Until Filing of Form N-600. 2. Physical Presence in the United States. H. Enter From (mm/dd/yyyy). Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the start date of an additional period of your physical presence in the United States in the format MM/DD/YYYY.
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| Part 6. Physical Presence in the United States From Birth Until Filing of Form N-600. 2. Physical Presence in the United States. H. Enter To (mm/dd/yyyy). Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the end date of an additional period of your physical presence in the United States in the format MM/DD/YYYY.
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| Place of Entry | ||
| Part 2. Information About You. 22. Have you been absent from the United States since you first arrived? F. Place of Entry Upon Return to the United States. Enter City or Town. Select State from a List of States | ComboBox |
Select the state from the list where you re-entered the United States after being absent.
MP
PA
FM
MH
MN
CO
ND
RI
NE
NM
FL
MS
OR
WA
MT
AA
AK
DE
VT
SC
IL
CA
MD
PR
UT
VI
NV
AS
AE
NH
PW
SD
WY
CT
KS
MA
MI
AR
VA
IA
ID
TN
KY
GU
AP
WV
GA
HI
NY
AL
IN
OK
WI
NJ
OH
TX
NC
DC
LA
ME
MO
AZ
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| Part 2. Information About You. 22. Have you been absent from the United States since you first arrived? F. Place of Entry Upon Return to the United States. Enter City or Town | Text |
Enter the city or town where you re-entered the United States after being absent. Maximum length is 40 characters.
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| Part 2. Information About You. 22. Have you been absent from the United States since you first arrived? C. Place of Entry Upon Return to the United States. Enter State. Select State from a List of States | ComboBox |
Select the state from the list where you re-entered the United States after being absent.
MP
PA
FM
MH
MN
CO
ND
RI
NE
NM
FL
MS
OR
WA
MT
AA
AK
DE
VT
SC
IL
CA
MD
PR
UT
VI
NV
AS
AE
NH
PW
SD
WY
CT
KS
MA
MI
AR
VA
IA
ID
TN
KY
GU
AP
WV
GA
HI
NY
AL
IN
OK
WI
NJ
OH
TX
NC
DC
LA
ME
MO
AZ
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| Part 2. Information About You. 22. Have you been absent from the United States since you first arrived? C. Place of Entry Upon Return to the United States. Enter City or Town. Enter City or Town | Text |
Enter the city or town where you re-entered the United States after being absent. Maximum length is 40 characters.
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| Preparer Information | ||
| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Full Name. 1. Preparer's Given Name (First Name) | Text |
Enter the given name (first name) of the person who prepared this application, if it is someone other than the applicant.
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| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Full Name. 1. Preparer's Family Name (Last Name) | Text |
Enter the family name (last name) of the person who prepared this application, if it is someone other than the applicant.
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| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Full Name. 1. Preparer's Business or Organizations Name (if any) | Text |
Enter the name of the business or organization of the person who prepared this application, if applicable.
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| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Mailing Address. Enter City or Town | Text |
Enter the city or town of the mailing address of the person who prepared this application.
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| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Mailing Address. If this address is outside the United States, enter the province or state, if applicable | Text |
If the mailing address of the person who prepared this application is outside the United States, enter the province or state, if applicable.
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| Preparer's Contact Information | ||
| Part 10. 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 preparing this application, if it is someone other than the applicant. This field is optional.
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| Part 10. 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 | Text |
Enter the daytime telephone number of the person preparing this application, if it is someone other than the applicant.
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| Part 10. 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) | Text |
Enter the mobile telephone number of the person preparing this application, if it is someone other than the applicant. This field is optional.
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| Preparer's Information | ||
| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Statement. 7. B. I am an attorney or accredited representative and my representation of the naturalization applicant in this case does not extend beyond the preparation of this request | CheckBox |
Check this box if you are an attorney or accredited representative and your representation of the naturalization applicant does not extend beyond the preparation of this request.
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| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Statement. 7. B. I am an attorney or accredited representative and my representation of the naturalization applicant in this case extends beyond the preparation of this request | CheckBox |
Check this box if you are an attorney or accredited representative and your representation of the naturalization applicant extends beyond the preparation of this request.
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| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Signature of Preparer. This form can not be signed electronically. The name of the preparer can not be typewritten into this space | Text |
Provide the signature of the person preparing this application if it is someone other than the applicant. Note that this form cannot be signed electronically and the name of the preparer cannot be typewritten into this space.
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| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Date of Signature. Enter the 2 digit month, 2 digit day and 4 digit year | Text |
Enter the date of the preparer's signature in the format MM/DD/YYYY.
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| Preparer's Mailing Address | ||
| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Mailing Address. Enter Postal Code | Text |
Enter the postal code of the preparer's mailing address.
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| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Mailing Address. Enter the state. You will be making a selection from a drop down box containing 2 letter abbreviations of state names | ComboBox |
Select the state of the preparer's mailing address from the dropdown list containing 2-letter state abbreviations.
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PA
FM
MH
MN
CO
ND
RI
NE
NM
FL
MS
OR
WA
MT
AA
AK
DE
VT
SC
IL
CA
MD
PR
UT
VI
NV
AS
AE
NH
PW
SD
WY
CT
KS
MA
MI
AR
VA
IA
ID
TN
KY
GU
AP
WV
GA
HI
NY
AL
IN
OK
WI
NJ
OH
TX
NC
DC
LA
ME
MO
AZ
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| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Mailing Address. Enter the Street Number and Name | Text |
Enter the street number and name of the preparer's mailing address.
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| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Mailing Address. Check Suite | CheckBox |
Check this box if the preparer's mailing address includes a suite.
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| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Mailing Address. Check Floor | CheckBox |
Check this box if the preparer's mailing address includes a floor.
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| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Mailing Address. If you checked the apartment, suite or floor box, enter the number here | Text |
If you checked the apartment, suite, or floor box, enter the corresponding number here.
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| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Mailing Address. Check Apartment | CheckBox |
Check this box if the preparer's mailing address includes an apartment.
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| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Mailing Address. Enter Country | Text |
Enter the country of the preparer's mailing address.
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| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Mailing Address. Zip Code Plus 4. Enter 5-digit Zip Code | Text |
Enter the 5-digit Zip Code for the mailing address of the person preparing this application, if it is someone other than the applicant.
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| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Mailing Address. Zip Code Plus 4. Enter 4-digit Zip Code Extension | Text |
Enter the 4-digit Zip Code extension for the mailing address of the person preparing this application, if it is someone other than the applicant.
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| Preparer's Statement | ||
| Part 10. Contact Information, Declaration, ans Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Statement. 7. A. I am not an attorney or accredited representative but have prepared this application on behalf of the applicant and with the applicant's consent. Check box | CheckBox |
Check this box if the person preparing this application is not an attorney or accredited representative but has prepared the application on behalf of the applicant with the applicant's consent.
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| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's Statement. 7. B. I am an attorney or accredited representative and my representation of the naturalization applicant in this case | CheckBox |
Check this box if the person preparing this application is an attorney or accredited representative and is representing the naturalization applicant in this case.
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| Previous Applications | ||
| Part 2. Information About You. 15. Have you previously applied for a Certificate of Citizenship or U.S. Passport? Check No | CheckBox |
Check this box if you have not previously applied for a Certificate of Citizenship or U.S. Passport.
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| Part 2. Information About You. 15. Have you previously applied for a Certificate of Citizenship or U.S. Passport? Check Yes | CheckBox |
Check this box if you have previously applied for a Certificate of Citizenship or U.S. Passport.
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| Re-adoption Information | ||
| Part 2. Information About You. 18. Did you have to be re-adopted in the United States? A. Place of Final Adoption. Enter City or Town | Text |
Enter the city or town where your re-adoption took place in the United States.
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| Part 2. Information About You. 18. Did you have to be re-adopted in the United States? A. Place of Final Adoption. Select State from a List of States | ComboBox |
Select the state where your re-adoption took place in the United States from the provided list of states.
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PA
FM
MH
MN
CO
ND
RI
NE
NM
FL
MS
OR
WA
MT
AA
AK
DE
VT
SC
IL
CA
MD
PR
UT
VI
NV
AS
AE
NH
PW
SD
WY
CT
KS
MA
MI
AR
VA
IA
ID
TN
KY
GU
AP
WV
GA
HI
NY
AL
IN
OK
WI
NJ
OH
TX
NC
DC
LA
ME
MO
AZ
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| Part 2. Information About You. 18. Did you have to be re-adopted in the United States? A. Place of Final Adoption. Enter City or Town | Text |
Enter the city or town where your re-adoption took place in the United States. Maximum length is 40 characters.
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| Part 2. Information About You. 18. Did you have to be re-adopted in the United States? C. Date Legal Custody Began (mm/dd/yyyy) | Text |
Enter the date when your legal custody began in the format mm/dd/yyyy.
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| Residence History | ||
| Part 4. Information About Your Residence. 1. Where have you lived during the last 5 years? Begin with where you live now and then list every location where you have lived during the last 5 years. If you need more space, use an additional sheet or sheets of paper. A. Mailing Address (if different from the address above). Enter C/O ("In Care Of" Name, if applicable) | Text |
Enter the 'In Care Of' name for your mailing address if it is different from the address above, and if applicable.
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| Residence Information | ||
| Part 4. Information About Your Residence. 1. Where have you lived during the last 5 years? Begin with where you live now and then list every location where you have lived during the last 5 years. If you need more space, use an additional sheet or sheets of paper. A. Mailing Address (if different from the address above). Enter C/O ("In Care Of" Name, if applicable) | Text |
Enter the 'In Care Of' name if applicable, for your mailing address if it is different from your current address. List all locations where you have lived during the last 5 years.
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| Residency and Custody | ||
| Part 2. Information About You. 18. Did you have to be re-adopted in the United States? 21. Do you regularly reside in the United States in the legal and physical custody of your U.S. citizen parents? Select No | CheckBox |
Select 'No' if you do not regularly reside in the United States in the legal and physical custody of your U.S. citizen parents.
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| Part 2. Information About You. 18. Did you have to be re-adopted in the United States? 21. Do you regularly reside in the United States in the legal and physical custody of your U.S. citizen parents? Select Yes | CheckBox |
Select 'Yes' if you regularly reside in the United States in the legal and physical custody of your U.S. citizen parents.
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| System Information | ||
| PDF417BarCode1 | Text |
This field contains a barcode that is automatically generated and should not be modified.
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| PDF417BarCode1 | Text |
This is a barcode field that contains encoded information about the form. It is automatically generated and should not be modified.
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| Travel History | ||
| Part 2. Information About You. 22. Have you been absent from the United States since you first arrived? A. Enter Date You Left the United States (mm/dd/yyyy). Enter To Date as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date you left the United States in the format MM/DD/YYYY. This is required if you have been absent from the U.S. since your first arrival.
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| Part 2. Information About You. 22. Have you been absent from the United States since you first arrived? B. Enter Date You Returned to the United States (mm/dd/yyyy). Enter To Date as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date you returned to the United States in the format MM/DD/YYYY. This is required if you have been absent from the U.S. since your first arrival.
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| Part 2. Information About You. 22. Have you been absent from the United States since you first arrived? C. Place of Entry Upon Return to the United States. Enter State. Enter To Date as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the state where you re-entered the United States. This is required if you have been absent from the U.S. since your first arrival.
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| Part 2. Information About You. 22. Have you been absent from the United States since you first arrived? E. Enter Date You Returned to the United States (mm/dd/yyyy). Enter Date as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date you returned to the United States in the format MM/DD/YYYY. This is required if you have been absent from the U.S. since your first arrival.
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| USCIS Officer Use Only | ||
| Part 13. Officer Report and Recommendation on Application for Certificate of Citizenship (for USCIS use ONLY) On the basis of the documents, records, the testimony of persons examined, and the identification upon personal appearance of the underage beneficiary, I find that all the facts and conclusions set forth under oath in this application are: 2. Check The applicant derived or acquired U.S. Citizenship | CheckBox |
This checkbox is for USCIS officers to indicate whether the applicant derived or acquired U.S. citizenship based on the documents, records, and testimony provided.
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| Part 13. Officer Report and Recommendation on Application for Certificate of Citizenship (for USCIS use ONLY). Enter Date of Signature as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
This field is for USCIS officers to enter the date of their signature in the format MM/DD/YYYY.
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| Part 13. Officer Report and Recommendation on Application for Certificate of Citizenship (for USCIS use ONLY). 3. Check The applicant derived or acquired U.S. citizenship through (Select the box next to the appropriate section of law, or if the section of law is not reflected, type or print the applicable section of law in the space next to “Other.”) | CheckBox |
This checkbox is for USCIS officers to indicate the section of law through which the applicant derived or acquired U.S. citizenship. If the section of law is not listed, the officer should type or print the applicable section in the space provided.
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| Part 13. Officer Report and Recommendation on Application for Certificate of Citizenship (for USCIS use ONLY) 3. A. Check I N A Section 3 0 1 | CheckBox |
This checkbox is for USCIS officers to indicate that the applicant derived or acquired U.S. citizenship through INA Section 301.
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| Part 13. Officer Report and Recommendation on Application for Certificate of Citizenship (for USCIS use ONLY) 3. B. Check I N A Section 3 0 9 | CheckBox |
This checkbox is for USCIS officers to indicate that the applicant derived or acquired U.S. citizenship through INA Section 309.
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| Part 13. Officer Report and Recommendation on Application for Certificate of Citizenship (for USCIS use ONLY) 3. C. Check I N A Section 3 2 0 | CheckBox |
This checkbox is for USCIS officers to indicate that the applicant derived or acquired U.S. citizenship through INA Section 320.
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| Part 13. Officer Report and Recommendation on Application for Certificate of Citizenship (for USCIS use ONLY) 3. D. Check I N A Section 3 2 1 | CheckBox |
This checkbox is for USCIS officers to indicate that the applicant derived or acquired U.S. citizenship through INA Section 321.
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| Part 13. Officer Report and Recommendation on Application for Certificate of Citizenship (for USCIS use ONLY) 3. E. Check Other | CheckBox |
This checkbox is for USCIS officers to indicate that the applicant derived or acquired U.S. citizenship through a section of law not listed, and they should specify the section in the space provided.
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| Part 13. Officer Report and Recommendation on Application for Certificate of Citizenship (for USCIS use ONLY) 3. E. If Other (explain) is Checked, Enter Explanation | Text |
This text field is for USCIS officers to provide an explanation if the 'Other' checkbox is selected for the section of law through which the applicant derived or acquired U.S. citizenship.
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| Part 13. Officer Report and Recommendation on Application for Certificate of Citizenship (for USCIS use ONLY) 4. Check The applicant has not been expatriated since that time | CheckBox |
This checkbox is for USCIS officers to indicate that the applicant has not been expatriated since acquiring U.S. citizenship.
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| Part 13. Officer Report and Recommendation on Application for Certificate of Citizenship (for USCIS use ONLY) Issue Certificate of Citizenship in the name of. Enter USCIS Officer's Title | Text |
This field is for USCIS officers to enter their title when issuing the Certificate of Citizenship.
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| Part 13. Officer Report and Recommendation on Application for Certificate of Citizenship (for USCIS use ONLY) Enter Date of Signature as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
This field is for USCIS officers to enter the date of their signature in the format MM/DD/YYYY.
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| Part 13. Officer Report and Recommendation on Application for Certificate of Citizenship (for USCIS use ONLY). U S C I S Officer's Signature. No Entry. Print and Sign completed form | Text |
This field is for the USCIS officer's signature. The officer must print and sign the completed form.
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| Part 13. Officer Report and Recommendation on Application for Certificate of Citizenship (for USCIS use ONLY). Enter Date of Signature as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
This field is for USCIS officers to enter the date of their signature in the format MM/DD/YYYY.
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| Part 13. Officer Report and Recommendation on Application for Certificate of Citizenship (for USCIS use ONLY). Check I do not concur with the USCIS Officer's recommendation of Form N- 6 00 | CheckBox |
This checkbox is for USCIS officers to indicate that they do not concur with the recommendation on Form N-600.
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| Part 13. Officer Report and Recommendation on Application for Certificate of Citizenship (for USCIS use ONLY). Check I do | CheckBox |
This checkbox is for USCIS officers to indicate that they concur with the recommendation on Form N-600.
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| USCIS Use Only | ||
| Part 13. Officer Report and Recommendation on Application for Certificate of Citizenship (for USCIS use ONLY) I recommend that this Form N- 600 be: Check Denied | CheckBox |
For USCIS use only. Check this box if the application is recommended to be denied.
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| Part 13. Officer Report and Recommendation on Application for Certificate of Citizenship (for USCIS use ONLY) I recommend that this Form N- 600 be: Check Approved | CheckBox |
For USCIS use only. Check this box if the application is recommended to be approved.
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| Part 13. Officer Report and Recommendation on Application for Certificate of Citizenship (for USCIS use ONLY) Issue Certificate of Citizenship in the name of. Enter Family Name (Last Name) | Text |
For USCIS use only. Enter the family name (last name) for the Certificate of Citizenship.
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| Part 13. Officer Report and Recommendation on Application for Certificate of Citizenship (for USCIS use ONLY) Issue Certificate of Citizenship in the name of. Enter Given Name (Last Name) | Text |
For USCIS use only. Enter the given name (first name) for the Certificate of Citizenship.
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| Part 13. Officer Report and Recommendation on Application for Certificate of Citizenship (for USCIS use ONLY) Issue Certificate of Citizenship in the name of. Enter Middle Name | Text |
For USCIS use only. Enter the middle name for the Certificate of Citizenship.
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| Part 13. Officer Report and Recommendation on Application for Certificate of Citizenship (for USCIS use ONLY) Issue Certificate of Citizenship in the name of. Enter USCIS Officer's Printed Name | Text |
For USCIS use only. Enter the printed name of the USCIS officer.
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| Part 13. Officer Report and Recommendation on Application for Certificate of Citizenship (for USCIS use ONLY) U S C I S Officer's Signature. No Entry. Print and Sign completed form | Text |
For USCIS use only. The USCIS officer should print and sign their name here.
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