Form I-612 Application for Waiver of the Foreign Residence Requirem

DRAFT - NOT FOR USE

OMB No. 1615-0030; Expires 06/30/07

I-612, Application for Waiver of the
Foreign Residence Requirement

Department of Homeland Security

[Under Section 212(e) of the INA, as Amended]

U.S. Citizenship and Immigration Services

Instructions
This application may be submitted only by an alien who believes that compliance with the foreign residence requirement of Section
212(e) of the Immigration and Nationality Act, as amended, would impose exceptional hardship on his or her spouse or unmarried
child(ren) under the age of 21 who is a citizen of the United States or a lawful permanent resident of the United States, or by an alien
who believes that returning to the country of his or her nationality or last residence would subject him or her to persecution on
account of race, religion or political opinion.
NOTE: Please read these instructions carefully. The application fee will not be refunded.

1. Foreign Residence Requirement.
In order to be eligible to apply for an immigrant visa or for
permanent residence in the United States, or for a
nonimmigrant visa as a temporary worker under section
101(a)(15)(H) or section 101(a)(15(L) of the INA, certain
exchange visitors (visa symbols J-1 and J-2) must reside
and be physically present in the country of their nationality
or last foreign residence for an aggregate of at least two
years following departure from the United States.

the nearest U.S. Citizenship and Immigration Services
(USCIS) office or American embassy or consulate will
respond to your concerns.

You, as an exchange visitor, are subject to the two-year
foreign residence requirements under Section 212(e) of the
INA if:

If you seek a waiver of the foreign residence requirement
on the basis that the foreign country of your citizenship/
nationality or last foreign residence has no objection to the
waiver, you should, if in the United States, apply directly
to the embassy of the country concerned; or if abroad, you
should inquire at your foreign ministry.

Your participation in the exchange program was
financed at any time in whole or in part, directly or
indirectly, by an agency of the U.S. Government or by
the government of your country of nationality or last
foreign residence; or
Prior to issuance of an exchange visitor visa, or
admission as an exchange visitor without a visa, or
acquisition of status as an exchange visitor, to
participate in an exchange program, your country of
nationality or last foreign residence was designated by
the U.S. Secretary of State as clearly requiring your
specialized knowledge or skill; or
You entered the United States as, or changed status to
that of an exchange visitor on or after January 10,
1977, to participate in graduate medical education or
training
Inquiries and Information
If you are a participant in an exchange program and
subject to the two-year foreign residence requirement
under 212(e) of the INA, your spouse and unmarried minor
child(ren) who were admitted as exchange visitors or
acquired such status after admission are also subject to this
requirement. If you have any question as to whether you
are subject to the two-year foreign residence requirement,

If you believe that a U.S. Government agency may be
officially interested in your case and may wish to request a
waiver on your behalf, you should inquire directly to that
agency concerning such request.

2. Eligibility for Waiver of the Two-Year Foreign
Residence Requirement.
Waiver of the two-year foreign residence requirement
under Section 212(e) of the INA may be authorized
only under the following circumstances:
You have a U.S. citizen or permanent resident spouse
or unmarried minor child(ren) and you establish in an
application to USCIS that compliance with the twoyear foreign residence requirement would impose
exceptional hardship on such spouse or child(ren).
You establish in an application to USCIS that returning
to your country of nationality or last foreign residence
would subject you to persecution on account of race,
religion or political opinion.
A U.S. government agency requests the Department of
State to recommend a waiver on your behalf for the
reason that compliance with the two-year foreign
residence requirement would be detrimental to a
program or activity of official interest to the agency.
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The country of your nationality or last foreign
residence furnishes the Department of State a written
statement that it has no objection to the waiver.

submitting a separate application on a separate Form I-612
for each individual. In such case, "B" should be checked
in Block 6 on each application.

A State Department of Public Health, or its equivalent,
or an interested U.S. government agency, requests the
Department of State to recommend a waiver on your
behalf as one who came to the United States or
acquired status in order to receive graduate medical
education or training, subject to the requirements of
Section 214(l) of the INA.

If you are in the United States, you must submit your
temporary entry permit (Form I-94, Arrival-Departure
Record) and the entry permit of your spouse and child
(ren), if he or she is in the United States and not a U.S.
citizen or lawful permanent resident. If the entry permit is
attached to the passport, remove and submit it for this
purpose. Do not submit the passport.

In no case may the two-year foreign residence requirement
be waived unless a favorable recommendation is made by
the Department of State.
NOTE: The Form I-612 may be submitted by an alien for
the purpose of establishing exceptional hardship to his or
her spouse or unmarried child(ren) under the age of 21
who is a citizen of the United States or a lawful permanent
resident of the United States, or establishing that returning
to his or her country of nationality or last foreign residence
would subject him or her to persecution on account of race,
religion or political opinion. See "Inquiries and
Information" for on Page 1 for details.

3. Submission of Application.
Mail your completed applications for exceptional hardship
and/or persecution claims to the California Service Center.
U.S. Department of Homeland Security
U.S. Citizenship and Immigration Services
California Service Center
P.O. Box 30111
Laguna Niguel, CA 92607-0111
OR
U.S. Department of Homeland Security
U.S. Citizenship and Immigration Services
California Service Center
24000 Avila Road, 2nd Floor, Room 2312
Laguna Niguel, CA 92677

4. Your Spouse or Unmarried Minor Child(ren).
If your spouse or child(ren) is or was an exchange alien
who is subject to the foreign residence requirement solely
because of a relationship to you, he or she may be included
in this application by checking "A" in Block 6 of Form
I-612. If your spouse or child(ren) is subject to the foreign
residence requirement because of participation in an
exchange program, your spouse or child(ren) may apply
for a waiver of the foreign residence requirement by

5. Preparation of Application.
The Form I-612 must be typed or printed legibly in black
ink, using block letters. If you are claiming exceptional
hardship on your U.S. citizen spouse or child(ren) or your
lawful permanent resident spouse or child(ren), Part 13
must be completely filled out identifying your spouse, if
any, and Part 14 must be filled out identifying your child
(ren), if any. Please annotate the date and country of birth
of your spouse and child(ren) as well as the nationality/
citizenship of your spouse and child(ren). If you are
claiming you cannot return to your country of nationality
or last foreign residence because you would be subject to
persecution on account of race, religion or political
opinion, Parts 13 and 14 may be left blank. You must
sign and date the Form1-612. The Form I-612 must be
signed and dated by the preparer, if someone other than
you filled out the Form I-612.

6. Documents in General.
You should submit legible copies of any and all original
supporting documents. Originals should only be provided
when asked for specifically. Any document in a foreign
language must be accompanied by a translation in English.
The translator must certify that he or she is competent to
translate and that the translation is accurate.

7. Supporting Documents.
The following documents must be submitted with the
Form I-612:
A. Documentation to prove the U.S. citizen or lawful
permanent residence status of your spouse or
unmarried child(ren) under age of 21 (if you
selected "A" in Block 5 of Form I-612):
-- If your spouse or child(ren) is a citizen by reason of
birth in the United States, submit:
A birth certificate of your spouse or child(ren); or
Form I-612 (Rev. 05/02/07) Y Page 2

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If a birth certificate is unobtainable, a copy of
the baptismal certificate (baptism must have
occurred within two months after birth) under
seal of the church, showing the place of birth; or
If the birth or baptismal certificate cannot be
obtained, affidavits of two U.S. citizens who
have personal knowledge of the birth of your
spouse or child(ren) in the United States.
-- If your spouse or child(ren) was born outside the
United States, became a citizen of the United States
through a parent, and has not been issued a
certificate of citizenship, submit evidence of the
citizenship and marriage of parent, as well as
termination of any prior marriages of parent, and
the birth certificate of the child(ren). Also submit a
separate statement showing the dates, ports of entry
and means of all arrivals and departures into and
from the United States by your U.S. citizen or
lawful permanent resident spouse or child(ren).
-- If the naturalization of your spouse or child(ren)
occurred within 90 days immediately preceding the
filing of this application, submit a copy of the
naturalization certificate.
-- If your spouse or child(ren) is a lawful permanent
resident of the United States, submit:
A copy of the front and back of their Form
I-551, Permanent Resident Card; or
If they do not have a Form I-551, submit copies
of the pages of their passport containing an
admission stamp showing entry as or adjustment
to a lawful permanent resident (LPR), as well as
the biographic page of the passport; or
If they do not have a passport, submit any other
available evidence of their lawful permanent
resident status.
B. Documentation to prove a relationship between you
and your U.S. citizen or lawful permanent resident
spouse or unmarried minor child(ren) (if you
selected "A" in Block 5 of Form I-612):
Every application must be accompanied by a certificate
of marriage to your spouse and proof of legal termination
of all previous marriages for both you and your spouse.
If the application is based on hardship to your U.S.
citizen or lawful permanent resident child(ren), also
submit the birth certificate(s) of the child(ren).

C. If you cannot return to your country of nationality
or of last foreign residence because the compliance
with the two year foreign residence requirement
would impose exceptional hardship on your U.S.
citizen or lawful permanent resident spouse and/or
child(ren):
-- Submit a statement from you, dated and signed,
detailing how your compliance with the foreign
residence requirement would impose exceptional
hardship on your U.S. citizen or lawful permanent
resident spouse and/or child(ren). Please describe
the exceptional hardship from two perspectives:
How it would impact your spouse and child(ren)
if they remain in the United States while you are
away for two years; and
The impact if they choose to accompany you to
your home country for two years.
-- If the hardship is based on a medical condition of
your U.S. citizen or lawful permanent resident
spouse and/or child(ren), submit a statement from a
physician describing the condition, its effect on the
patient's day-to-day life and explaining the
treatment and the length of time treatment would be
required.
-- If your and/or your spouse's income and savings are
pertinent to a finding of hardship, provide a
statement containing relevant information about the
income and savings.
-- You may submit any documentary evidence
available that you believe affects the exceptional
hardship.

D. If you cannot return to your country of nationality
or of last foreign residence because you would be
subject to persecution on account of race, religion
or political opinion:
-- Please detail this information in your own dated and
signed statement. Please provide as much detail as
possible. If you have any documentation to support
your assertions, please provide them as well.
-- In addition to your own required statement, you
may submit any documentary evidence available
that you believe affects the persecution issues.
Form I-612 (Rev. 05/02/07) Y Page 3

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8. Penalties.
Upon signing the application in Part 16 of the Form I-612,
you certify under penalty of perjury under the laws of the
United States of America that all statements made in the
Form I-612 as well as any supporting evidence or
documentation are true and correct.
Severe penalties are provided by law for knowingly and
willfully falsifying or concealing a material fact or using
any false document in the submission of an application.

9. USCIS Forms and Information.
To order USCIS forms, call our toll-free forms line at
1-800-870-3676. You can also get USCIS forms and
information on immigration laws, regulations or
procedures by calling our National Customer Service
Center at 1-800-375-5283 or visiting our internet website
at www.uscis.gov.

10. What Is the Fee?
A fee of $265.00 must be paid for filing this application.
The fee cannot be refunded regardless of the action taken
on the application. Do not mail cash. All fees must be
submitted in the exact amount.
Payment by check or money order must be drawn from a
bank or other institution located in the United States and
be payable in United States currency.
If you reside in Guam, the check or money order must be
payable to the "Treasurer, Guam."
If you reside in the U.S. Virgin Islands, the check or
money order must be payable to the "Commissioner of
Finance of the Virgin Islands."
All other applicants must make the check or money order
payable to the Department of Homeland Security.
When the check is drawn on account of a person other than
the applicant, the name of the applicant must be entered on
the face of the check. If the application is submitted from
outside the United States, remittance may be made by bank
international money order or foreign draft drawn on a
financial institution in the United States and payable to the
Department of Homeland Security in U.S. currency.

Personal checks are accepted subject to collection. An
uncollected check will render the application and any
document issued pursuant thereto invalid. A charge of
$30.00 will be imposed if a check in payment of a fee is
not honored by the bank on which it is drawn.
How to Check If the Fee Is Correct.
The fee on this form is current as of the edition date
appearing in the lower right corner of this page. However,
because USCIS fees change periodically, you can verify if
the fee is correct by following one of the steps below:
Visit our website at www.uscis.gov and click on
"Immigration Forms" to check the appropriate fee; or
Review the Fee Schedule included in your form
package, if you called us to request the form; or
Telephone our National Customer Service Center
at1-800-375-5283 and ask for the fee information.

11. Use InfoPass to Make an Appointment.
As an alternative to waiting in line for assistance at your
local USCIS office, you can now schedule an appointment
through our internet-based system, InfoPass. To access the
system, visit our website at www.uscis.gov. Use the
InfoPass appointment scheduler and follow the screen
prompts to set up your appointment. InfoPass generates an
electronic appointment notice that appears on the screen.
Print the notice and take it with you to your appointment.
The notice gives the time and date of your appointment,
along with the address of the USCIS office.

12. Public Reporting Burden.
A person is not required to respond to a collection of
information unless it displays a currently valid OMB
number. The reporting burden for this collection of
information is estimated to average 20 minutes per
response, including the time of reviewing instructions,
searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the
collection of information. If you have suggestions on how
to reduce this burden or to make the form simpler, write to
the U.S. Citizenship and Immigration Services, Regulatory
Management Division,111 Massachusetts Avenue, N.W.,
3rd Floor, Suite 3008, Washington, DC 20529;OMB No.
1615-0030. Do not mail your completed application to
this address.

Form I-612 (Rev. 05/02/07) Y Page 4

DRAFT - NOT FOR USE

OMB No. 1615-0030; Expires 06/30/07

I-612, Application for Waiver of the
Foreign Residence Requirement

Department of Homeland Security

[Under Section 212(e) of the INA, as Amended]

U.S. Citizenship and Immigration Services
Action Block

Fee Stamp

1. Name (Last in CAPS)

First

Middle

1a. If you are a married woman, give your maiden name.

1b. Include all other previously used names, including aliases, tribal names, etc.

2. Mailing Address (Apt. No.)

(Number and Street)

Present or last U.S. residence

(Town or City)

(Number and Street)

3. Date of Birth Place of Birth (City/Town, Province/State/Country)
(mm/dd/yyyy)

Alien Registration Number (A#), (if known)

(State or Province)

(Zip Code, if in U.S.)

(Country)

(State)

(City)

(Zip Code)

Country of Citizenship/Nationality

Country of Last Foreign Residence
(City/Town, Province/State/Country)

Telephone Number (With area code)

E-Mail Address, if any

4. I believe I am subject to the foreign residence requirements because: (Check appropriate box(es)).
A.

I participated in an exchange program that was financed by an agency of the U.S. Government or the government of the country of my
nationality or last foreign residence for the purpose of promoting international educational and cultural exchange.

B.

An agency of the Government of the United States or the government of the country of my nationality or last foreign residence gave me a grant
(such as a Fullbright grant), stipend or allowance for the purpose of participation in an exchange program. Name of U.S. Government agency
or foreign country:

C.

I became an exchange visitor after the U.S. Secretary of State designated the country of my nationality or last foreign residence as clearly requiring
the services of persons with my specialized knowledge or skill.

D.

I entered the United States as, or my status was changed to that of, an exchange visitor on or after January 10, 1977 to participate in graduate
medical education or training.

.

5. I am applying for a waiver of the foreign residence requirement on the ground that: (Check appropriate box(es)).
A.

My departure from the United States would impose exceptional hardship on my U.S. citizen or lawful permanent resident spouse or child.

B.

I cannot return to the country of my nationality or last foreign residence because I would be subject to persecution on account of race,
religion or political opinion.

IMPORTANT ADVISORY: If you have checked "A" under Number 5, you must attach to this application a statement dated and signed by you giving a detailed
explanation of the basis for your belief that compliance by you with the two-year foreign residence requirement of Section 212(e) of the Immigration and
Nationality Act, as amended, would impose exceptional hardship on your spouse or child who is a citizen of the United States or a lawful permanent resident
thereof. Without such statement your application is incomplete. You must include in the statement all pertinent information concerning the income and savings of
yourself and your spouse. Attach also documentary evidence as may be available to support the allegations of hardship.
If you have checked "B" under Number 5, you must attach a statement dated and signed by you setting forth in detail the reason(s) you believe why you cannot
return to the country of your nationality or last foreign residence because you would be subject to persecution on account of race, religion or political opinion.
Attach also documentary evidence as may be available to support the allegations of persecution.
6. If married, check appropriate box(es):
A.
Remarks

(See Instructions, Number 4, Spouse of Applicant.)

My spouse is included in this application.

B.

My spouse is filing a separate application for a waiver.
RECEIVED

TRANS. IN

RET'D
TRANS. OUT

COMPLETED

Form I-612 (Rev. 05/02/07) Y Y

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7. List all program numbers and names of all program sponsors.

8. Major field of activity (Check one)

9. Occupation

(1) Agriculture

(4) Engineering

(7) Natural and Physical Sciences

(2) Business Administration

(5) Humanities

(8) Social Sciences

(3) Education

(6) Medicine

(9) Other

10. Date and port of last arrival in the United States as a participant in a designated exchange program.

12. Number of prior marriages of applicant

11. If you are now abroad, give date of departure from United States.

If married, number of prior marriages of applicant's spouse
13. Name of Spouse

Date and Country of Birth

Nationality/Citizenship

Country of Last Foreign Residence

14. Names of Children

Date and Country of Birth

Nationality/Citizenship

Country of Last Foreign Residence

15. If you checked "A" under Number 5 on Page 1 of this form, provide the following information concerning your spouse or one of your children who is a citizen
of the United States and who you believe would suffer exceptional hardship if you resided outside the United States for two years following your departure from
this country.
If the U.S. citizenship of spouse or child was acquired through naturalization, give the following:
Name of U.S. citizen spouse or child:

U.S. citizenship of spouse or child was acquired through (check one)
Birth in the United States

Number of Naturalization Certificate

Date of Naturalization

Naturalization

Parent(s)

Place of Naturalization

If the U.S. citizenship of spouse or child was acquired through parent(s), has the spouse or child obtained a Certificate of Citizenship?
If so, give the number of the certificate

If not, submit evidence in accordance with Instruction 8, Supporting Documents.

16. If you checked "A" under Number 5 on Page 1 of this form and you do not have a spouse or child who is a citizen of the United States, provide the following
information concerning your spouse or one of your children who is a lawful permanent resident of the United States and who you believe would suffer
exceptional hardship if you resided outside the United States for two years following your departure from this country.
Name of lawful resident alien spouse or child:

Alien Registration Number (A#)

Date, place and means of admission for lawful permanent residence:

17. APPLICANT'S CERTIFICATION: I certify, under penalty of perjury under the laws of the United States of America, that the foregoing is true and correct.
Executed on
(Date)

(Place)

(Signature of applicant)

SIGNATURE OF PERSON PREPARING FORM, IF OTHER THAN APPLICANT: I declare that this document was prepared by me at the request of the
applicant and is based on all information of which I have any knowledge:

(Signature)

(
(Address of person preparing form, if other than applicant)

(Date)

(Occupation)

(Telephone Number)

(E-Mail Address, if any)

)

Form I-612 (Rev. 05/02/07) Y Page 2