USCIS's Electronic Immigration System (USCIS ELIS)

Supplemental Biographic Information

Page 1 of 2

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

PART 1 INFORMATION ABOUT YOU

1.a. Do you have a
USCIS Account
Identifier?

Yes

No

2.b. Do you have an
Alien Registration
Number?

No

3. Purpose for creating
this form? (Select one)

Yes

1.b. Account
Identifier

2.b. Alien
Registration #

5. Physical Address
Street Number
Street Name
Apartment Number
City or Town
State
Zip Code
Province
Postal Code
Country

6. Mailing Address
(If different from
Physical Address)
In Care of Name
Street Number
Street Name or
PO Box
Apartment Number
City or Town
Zip Code
Province
Postal Code
Country

Initial submission
as directed by
instructions on a
benefit request.

To update my
existing account.

4. Your Full Name
Family Name (Last)
Given Name (First)
Middle Name
(If your name has
changed due to
marriage, divorce,
or other reasons,
you must submit
evidence of the
legal name change.)

PART 2 YOUR EMPLOYMENT HISTORY Include all employment in the United States and/or other countries.
(to be completed for each employer for the past 5 years, starting with most recent employer) (Multiple Entries)

1. Current or most
recent employer
name

2. Current or most
recent employer
address
Street Number
Street Name
Apartment Number
City or Town
State
Zip Code
Province
Postal Code
Country

3. Date employment
began: (Date)

4. Date employment
ended: (Date)

5. Your occupation

Go to
Part 3

Supplemental Biographic Information

Page 2 of 2

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

PART 3 YOUR EDUCATIONAL HISTORY Include all education in the United States and/or in other countries.
(to be completed for all education you have received, starting with most recent education) (Multiple Entries)

1. Educational
Institution Name

2. Educational
Institution Location
City or Town
State
Province
Country

3. Date of
attendance from:
(Date)

4. Date of
attendance to:
(Date)

5. List any degree
received

6. List major field
of study

PART 4 YOUR RESIDENCE HISTORY Include all residences in the United States and/or in other countries.
(to be completed for each address for the past 5 years, starting with most recent address) (Multiple Entries)

1. Prior Address
Street Number
Street Name
Apartment Number
City or Town
State
Zip Code
Province
Postal Code
Country

3. On or about
what date did you
stop residing at
the listed
address? (Date)

2. On or about
what date did you
begin residing at
the listed
address? (Date)

SIGNATURE OF APPLICANT OR PETITIONER
If you knowingly and willfully falsify or conceal a material fact or submit a false document with your benefit request, we will deny
your benefit request and may deny any other immigration benefit. In addition, you will face severe penalties provided by law
and may be subject to criminal prosecution.

4.a. Signature
of Applicant or
Petitioner

4.b. Date of
Signature