I-102 Form TOC

TABLE OF CHANGES – FORM I-102

OMB No. 1615-0079

January 19, 2012

LOCATION	CURRENT VERSION	PROPOSED VERSION
Page 1, Information About You .		Pages 1 – 2, Renumbered this section as: 1.a. Family Name (Last Name) (fillable) 1.b. Given Name (First Name) (fillable) 1.c. Middle Name (fillable) Mailing Address 2.a. -2.i. Other Information 5. – 12.
Page 1, Reason for Application		Page 2, Renumbered to 1.a., 1.b., 1.c., 1.d., 1.e., 1.f., 1.g.
Page 2, Part 3. Processing Information		Page 2, Renumbered to 1.a., 1.b., 2.a., 2.b. 3.a. Family Name (Last Name) (fillable) 3.b. Given Name (First Name) (fillable) 3.c. Middle Name (fillable) 4. Class of Admission (fillable) 5. Place of Admission (fillable)
Page 2, Part 4. Signature	(Read the information on penalties in the instructions before completing this section. You must file this application in the United States.) I certify, under penalty of perjury under the laws of the United States of America, that this application and the evidence submitted with it is all true and correct. I authorize the release of any information from my records that U.S. Citizenship and Immigration Services needs to determine eligibility for the benefit I am seeking. Signature: (fillable) Daytime Telephone Number (With area code): (fillable) Date (mm/dd/yyy): (fillable)	Page 3, Part 4. Signature of Applicant I certify, under penalty of perjury under the laws of the United States of America, that this application and the evidence submitted with it is all true and correct. I authorize the release of any information from my records that U.S. Citizenship and Immigration Services needs to determine eligibility for the benefit I am seeking. 1.a. Signature of Applicant (fillable) 1.b. Date of Signature (mm/dd/yyy) (fillable) 1.c. Daytime Phone Number (fillable) NOTE: If you do not completely fill out this form or fail to submit required documents listed in the instructions, your application may be denied.
Page 2, Part 5. Signature of Person Preparing Form, if Other Than Above	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 (fillable) Print or Type Your Name (With area code) (fillable) Date (mm/dd/yyyy) (fillable)	Page 3, NOTE: If you are an attorney or representative, you must submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, along with this application. 1.a. Preparer’s Family Name (Last Name) (fillable) 1.b. Preparer’s Given Name (First Name) (fillable) 2. Preparer’s Business or Organization Name (fillable) Preparer’s Mailing Address 3.a. Street Number and Name (fillable) 3.b. Apartment/Suite/Floor (fillable) 3.c. City or Town (fillable) 3.d. State (fillable) 3.e. Zip Code (fillable) 3.f. Postal Code (fillable) 3.g. Province (fillable) 3.h. Country (fillable) Preparer’s Contact Information 4. Prepeparer’s Daytime Phone Number (fillable) Extension (fillable) 5. Prepeparer’s E-mail Address (if any) (fillable) Declaration To be completed by all preparers, including attorneys and authorized representatives: I declare that I prepared this benefit request at the request of the applicant, that it is based on all the information of which I have knowledge, and that the information is true to the best of my knowledge. 6.a. Signature of Preparer (fillable) 6.b. Date of Signature (mm/dd/yyyy) (fillable) NOTE: If you require more space to provide any additional information, use a separate sheet of paper. You must include your name and Alien Registration Number at the top of each sheet.