Form I-360 Petition for Amerasian, Widow or Special Immigrant

OMB No. 1615-0020; Expires 07/31/07

I-360, Petition for Amerasian,
Widow(er) or Special Immigrant

Department of Homeland Security
U.S. Citizenship and Immigration Services

START HERE - Please type or print in black ink.

For USCIS Use Only

Part 1. Information about person or organization filing this
petition. (Individuals should use the top name line; organizations should

use the second line.) If you are a self-petitioning spouse or child and do not
want USCIS to send notices about this petition to your home, you may
show an alternate mailing address here. If you are filing for yourself and
do not want to use an alternate mailing address, skip to part 2.
Given Name

Family Name

Apt.
#

State or
Province

Country

Zip/Postal
Code
IRS Tax #
(if any)

A
#

Part 2. Classification Requested (check one):
Amerasian
Widow(er) of a U.S. citizen who died within the past two (2) years
Special Immigrant Juvenile
Special Immigrant Religious Worker
Special Immigrant based on employment with the Panama Canal Company, Canal
Zone Government or U.S. Government in the Canal Zone
Special Immigrant Physician
Special Immigrant International Organization Employee or family member
Special Immigrant Armed Forces Member
Self-Petitioning Spouse of Abusive U.S. Citizen or Lawful Permanent Resident
Self-Petitioning Child of Abusive U.S. Citizen or Lawful Permanent Resident
Other, explain:

f.
g.
h.
i.
j.
k.

Resubmitted

Reloc Sent

Street Number
and Name
City

a.
b.
c.
d.
e.

Receipt

Middle Name

Company or Organization
Name
Address - C/O

U.S. Social
Security #

Returned

Reloc Rec'd

Petitioner/
Applicant
Interviewed
Beneficiary
Interviewed
I-485 Filed Concurrently
Bene "A" File Reviewed
Classification
Consulate
Priority Date
Remarks:

Part 3. Information about the person this petition is for.
Family Name

Given Name

Middle Name

Action Block

Address - C/O
Street Number
and Name
City
Country
Date of Birth
(mm/dd/yyyy)
U.S. Social
Security #
Marital Status:

Apt.
#
State or
Province
Country of
Birth
A#
(if any)

Single
Married
Divorced
Complete the items below if this person is in the United States:
Date of Arrival
I-94#
(mm/dd/yyyy)
Current Nonimmigrant
Status

Expires on
(mm/dd/yyyy)

Zip/Postal
Code
To Be Completed by

Widowed

Attorney or Representative, if any
Fill in box if G-28 is attached to
represent the applicant
VOLAG#
ATTY State License #

Form I-360 (Rev. 07/30/07) Y

Part 4. Processing Information.
Below give information on U.S. Consulate you want notified if this petition is approved and if any requested adjustment of status cannot be granted.
American Consulate:

Country

City

If you gave a United States address in Part 3, print the person's foreign address below. If his or her native alphabet does not use Roman letters, print
his or her name and foreign address in the native alphabet.
Name
Address
Gender of the person this petition is for.

Male

Female

Are you filing any other petitions or applications with this one?

No

Yes (How many?

Is the person this petition is for in deportation or removal proceedings?

No

Yes (Explain on a separate sheet of paper)

Has the person this petition is for ever worked in the U.S. without permission?

No

Yes (Explain on a separate sheet of paper)

Is an application for adjustment of status attached to this petition?

No

Yes

)

Part 5. Complete only if filing for an Amerasian.
Section A. Information about the mother of the Amerasian
Family Name
Living?

Given Name

No (Give date of death

)

Middle Name

Yes (complete address line below)

Unknown (attach a full explanation)

Address
Section B. Information about the father of the Amerasian: If possible, attach a notarized statement from the father regarding parentage.
Explain on separate paper any question you cannot fully answer in the space provided on this form.
Family Name

Given Name

Date of Birth
(mm/dd/yyyy)

Country of
Birth

Living?

No (Give date of death

)

Middle Name

Yes (complete address line below)

Unknown (attach a full explanation)

Home Address
Home
Phone #

(

Work
Phone #

)

(

)

At the time the Amerasian was conceived:
The father was in the military (indicate branch of service below - and give service number here):
Army

Air Force

Navy

Marine Corps

Coast Guard

The father was a civilian employed abroad. Attach a list of names and addresses of organizations which employed him at that time.
The father was not in the military, and was not a civilian employed abroad. (Attach a full explanation of the circumstances.)

Part 6. Complete only if filing for a Special Immigrant Juvenile Court Dependent.
Section A. Information about the Juvenile
List any other
names used.
Answer the following questions regarding the person this petition is for. If you answer "No," explain on a separate sheet of paper.
Is he or she still dependent upon the juvenile court or still legally committed to or under the custody of an agency
or department of a state?
No
Yes
Does he or she continue to be eligible for long term foster care?

No

Yes
Form I-360 (Rev. 07/30/07)Y Page 2

Part 7. Complete only if filing as a Widow/Widower, a Self-petitioning Spouse of an Abuser,
or as a Self-petitioning Child of an Abuser.
Section A. Information about the U.S. citizen husband or wife who died or about the U.S. citizen or lawful permanent resident abuser.
Family Name
Date of Birth
(mm/dd/yyyy)

Given Name
Country of
Birth

He or she is now, or was at time of death a (check one):

Section

Middle Name
Date of Death
(mm/dd/yyyy)

U.S. citizen through Naturalization (Show A #)

U.S. citizen born in the United States.

U.S. lawful permanent resident (Show A #)

U.S. citizen born abroad to U.S. citizen parents.

Other, explain

B. Additional Information about you.

How many times
have you been married?

How many times was the person in
Section A married?

Give the date and place where you and the person in Section A
were married. (If you are a self-petitioning child, write: "N/A")

When did you live with the person named in Section A? From (Month/Year)

until (Month/Year)

If you are filing as a widow/widower, were you legally separated at the time of the U.S citizens's death?

Yes, (attach explanation).

No

Give the last address at which you lived together with the person named in Section A, and show the last date that you lived together with that
person at that address:

If you are filing as a self-petitioning spouse, have any of your children filed separate self-petitions?

No

Yes (show child(ren)'s full names):

Part 8. Information about the spouse and children of the person this petition is for.

A widow/widower or a self-petitioning spouse of an abusive citizen or lawful permanent resident should also list the children of the deceased spouse
or of the abuser.
A. Family Name
Country of Birth
B. Family Name
Country of Birth
C. Family Name
Country of Birth
D. Family Name
Country of Birth
E. Family Name
Country of Birth

Given Name
Relationship

Middle Name

Relationship

Middle Name

Middle Name

Relationship

Middle Name

Relationship

Middle Name

Child

Date of Birth
(mm/dd/yyyy)
A#

Child

Given Name

Date of Birth
(mm/dd/yyyy)
A#

Child

Given Name

Date of Birth
(mm/dd/yyyy)
A#

Child

Given Name
Relationship

A#

Spouse
Child

Given Name

Date of Birth
(mm/dd/yyyy)

Date of Birth
(mm/dd/yyyy)
A#
Form I-360 (Rev. 07/30/07)Y Page 3

Part 8. Information about the spouse and children of the person this petition is for. (Continued.)
F. Family Name
Country of Birth
G. Family Name
Country of Birth
H. Family Name
Country of Birth

Part 9. Signature.

Given Name
Relationship

Middle Name

Relationship

Middle Name

Middle Name

Child

Date of Birth
(mm/dd/yyyy)
A#

Child

Given Name
Relationship

A#

Child

Given Name

Date of Birth
(mm/dd/yyyy)

Date of Birth
(mm/dd/yyyy)
A#

Read the information on penalties in the instructions before completing this part. If you are going to file this petition at
a USCIS office in the United States, sign below. If you are going to file it at a U.S. consulate or USCIS office overseas,
sign in front of a USCIS or consular official.

I certify, or, if outside the United States, I swear or affirm, under penalty of perjury under the laws of the United States of America, that this petition
and the evidence submitted with it is all true and correct. If filing this on behalf at an organization, I certify that I am empowered to do so by that
organization. I authorize the release of any information from my records, or from the petitioning organization's records, that the U.S. Citizenship and
Immigration Services needs to determine eligibility for the benefit being sought.
Signature
Signature of USCIS
or Consular Official

Date
Print Name

Date

NOTE: If you do not completely fill out this petition or fail to submit required documents listed in the instructions, the person(s) filed for may not
be found eligible for a requested benefit and the petition may be denied.

Part 10. Signature of person preparing form, if other than above. (Sign below.)
I declare that I prepared this application at the request of the above person and it is based on all information of which I have knowledge.
Signature

Print Your Name

Date

Firm Name
and Address

Form I-360 (Rev. 07/30/07)Y Page 4