Form I-600 Form I-600 Petition to Classify Orphan as an Immediate Relative and

OMB No. 1615-0028; Expires 12/31/10
Department of Homeland Security
U.S. Citizenship and Immigration Services

Form I-600, Petition to Classify
Orphan as an Immediate Relative

DRAFT

Fee Stamp

TO THE U.S. SECRETARY OF STATE:
The petition was filed by:
Married petitioner

Unmarried petitioner

The petition is approved for orphan:
Adopted abroad

Coming to U.S. for adoption.
Pre adoption requirements have
been met

Remarks:

File Number:
DATE OF FAVORABLE
DETERMINATION
DD
DISTRICT

Type or print legibly in black ink. Complete a separate petition for each child.
Petition is being made to classify the named orphan as an immediate relative.
BLOCK I - Information About Petitioner
1. My name is: (Last)

(First)

(Middle)

2. Other names used (including maiden name if appropriate):

3. I reside in the U.S. at:

6. My telephone number is: (include area code)

7. I am a citizen of the United States through:
Birth
Parents
Naturalization
If acquired through naturalization, provide the following:

(C/O if appropriate)

a. Name under which you naturalized:
(Apt. No.)

(Number and Street)

b. Naturalization certificate number:
(Town or City)

(State) (Zip Code)
c. Date of naturalization (mm/dd/yyyy):

4. Address abroad (if any):

d. Place of naturalization:
(Apt. No.)

(Number and Street)
(Town or City)

If acquired through parentage, have you obtained a
certificate in your own name based on that acquisition?

(State or Province)

No

(Country)

Yes

If not, submit evidence of citizenship. See Page 2 of the
instructions.

5. I was born on: (mm/dd/yyyy)
In:
(Town or City)

Have you or any person through whom you claimed
citizenship ever lost U.S. citizenship?

(State or Province)

No
(Country)
Received

Trans. In

Ret'd Trans. Out

Yes (If "Yes," attach detailed
explanation)

Completed

Form I-600 (Rev. 08/20/10) Y

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BLOCK I - Information About the Prospective Adoptive Parent (Continued)
8. My marital status is:
a.

Widowed

Married

b. I have been married

Single

Divorced

time(s)

9. If you are now married, provide the following information:
Date of present marriage (mm/dd/yyyy):

Place of present marriage:

Name of present spouse:
(Last)

(First)

(Middle)

Date of birth of present spouse (mm/dd/yyyy):

My spouse has been married
My spouse resides:

With me

(Maiden, if any)

Place of birth of present spouse:

time(s)
Apart from me (provide address below)

(Number and Street)

(Apt. No.) (City)

(State)

(Country)

BLOCK II - Information About Orphan Beneficiary
10. Name at birth:

(Last)

(First)

(Middle)

(First)

(Middle)

11. Name at present:

(Last)

12. Any other names by which orphan is or was known:

13. Gender:

Male

14. Date of birth (mm/dd/yyyy):

Female

15. Place of birth:

(City)

(State or Province)

16. The beneficiary is an orphan because (check one):

He or she has no parents

(Country)
He or she has only one parent who
is the sole or surviving parent

17. If the orphan has only one parent, answer the following:
a. State what has become of the other parent:

b. Is the remaining parent capable of providing for the orphan's support?

No

Yes

c. Has the remaining parent in writing irrevocably released the orphan for emigration and adoption?

No

Yes

Form I-600 (Rev. 08/20/10) Y Page 2

DRAFT
BLOCK II - Information About Orphan Beneficiary

(Continued)

18. Has the orphan been adopted abroad by the petitioner and spouse jointly or the unmarried petitioner?

No

Yes

If "Yes," did the petitioner and spouse or unmarried petitioner personally see and observe the child
prior to or during the adoption proceedings?

No

Yes

a. Does the petitioner and spouse jointly or does the unmarried petitioner intend to adopt the
orphan in the United States?

No

Yes

b. Have the preadoption requirements, if any, of the orphan's proposed State of residence been
met?

No

Yes

c. If b is answered "No," will they be met later?

No

Yes

No

Yes

Date of adoption (mm/dd/yyyy)

Place of adoption

19. If either answer in Question 18 is "No," answer the following:

20. To petitioner's knowledge, does the orphan have any physical or mental affliction?
If "Yes," name the affliction.

21. Who has legal custody of the child?

22. Name of child welfare agency, if any, assisting in this case:

23. Name of attorney abroad, if any, representing petitioner in this case:
Address of above attorney abroad:

24. Address in the United States where orphan will reside:

25. Present address of orphan:

26. If orphan is residing in an institution, give full name of institution:

27. If orphan is not residing in an institution, give full name of person with whom residing:

28. Give any additional information necessary to locate orphan, such as name of district, section, zone, or locality in which orphan
resides:

Form I-600 (Rev. 08/20/10) Y Page 3

DRAFT
BLOCK II - Information About Orphan Beneficiary

(Continued)

29. Location of U.S. Embassy or consulate where application for visa will be made:

(City in Foreign Country)

(Foreign Country)

BLOCK III - Accommodations for Individuals With Disabilities and Impairments (Read the information in the instructions
before completing this section.)
30. I am requesting an accommodation:
A. Because of my disability(ies) and/or impairment(s).

No

Yes

B. For my spouse because of his or her disability(ies) and/or impairment(s).

No

Yes

C. For my household member because of his or her disability(ies) and/or impairment(s).

No

Yes

If you answered "Yes," check any applicable box. Provide information on the disability(ies) and/or impairment(s) for each
person:
Deaf or hard of hearing and request the following accommodation(s) (if requesting a sign-language interpreter, indicate
which language (e.g., American Sign Language)):

Blind or sight-impaired and request the following accommodation(s):

Other type of disability(ies) and/or impairment(s) (describe the nature of the disability(ies) and/or impairment(s) and
accommodation(s) being requested):

Certification of Petitioner

Certification of Married Prospective Petitioner's Spouse

I certify, under penalty of perjury under the laws of the United States
of America, that the foregoing is true and correct, and that I will care
for an orphan or orphans properly if admitted to the United States.

I certify, under penalty of perjury under the laws of the United States
of America, that the foregoing is true and correct, and that my
spouse and I will care for an orphan or orphans properly if admitted
to the United States.

(Signature of Petitioner)

(Signature of Petitioner's Spouse)

Executed on (Date)

Executed on (Date)

Signature of Person Preparing Form, If Other Than Petitioner
I declare that this document was prepared by me at the request of the petitioner and is based entirely on information of which I have knowledge.

(Signature)

Executed on (Date)

Street Address and Room or Suite No./City/State/Zip Code

Form I-600 (Rev. 08/20/10) Y Page 4