I918-FRM-TOC-30Day

TABLE OF CHANGES - FORM I-918

Form I-918, Petition for U Nonimmigrant Status

OMB No 1615-0104

1/17/2017

Reason For Revision: Reformatted form to be in 2 column format and incorporated I-94 data collections, Child Soldier question, standard language, and new signature sections into form.

Current Page Number and Section	Current Text	Proposed Text
Page 1, To be completed by an attorney or accredited representative (if any).	To be completed by attorney or representative (if any). Fill in box if G-28 is attached to represent the applicant. ATTY State License Number:	[Page 1] To be completed by an attorney or accredited representative (if any). Select this box if Form G-28 is attached. Attorney State Bar Number (if applicable) Attorney or Accredited Representative USCIS Online Account Number (if any)
Page 1, Part 1. Information About You	Part 1. Information About You (Person filing this petition as a victim) Family Name Given Name Middle Name Other Names Used (Include maiden name/nickname) Home Address – Street Number and Name Apt. No. City State/Province Zip/Postal Code Safe Mailing Address (if other than above) – Street Number and Name Apt. No. C/O (in care of): City State/Province Zip/Postal Code Home Telephone No. (with area code) Safe Daytime Phone No. (with area code) E-Mail Address (optional) A-No. (if any) U.S. Social Security No. (if any) Marital Status Single/Married/Divorced/Widowed Gender Date of Birth (mm/dd/yyyy) Country of Birth Country of Citizenship I-94 No. (Arrival Departure Document) Passport No. Place of Issuance Date of Issue (mm/dd/yyyy) Place of Last Entry Date of Last Entry (mm/dd/yyyy) Current Immigration Status	[Page 1] START HERE - Type or print in black or blue ink. Part 1. Information About You (Person filing this petition as a victim) 1.a. Family Name (Last Name) 1.b. Given Name (First Name) 1.c. Middle Name Other Names Used (Include maiden name, nicknames, and aliases, if applicable) 2.a. Family Name (Last Name) 2.b. Given Name (First Name) 2.c. Middle Name Home Address 3.a. Street Number and Name 3.b. Apt. Ste. Flr. [Fillable Field] 3.c. City or Town 3.d. State 3.e. ZIP Code 3.f. Province 3.g. Postal Code 3.h. Country Safe Mailing Address (if other than Home Address) 4.a. In Care Of Name 4.b. Street Number and Name 4.c. Apt. Ste. Flr. [Fillable Field] 4.d. City or Town 4.e. State 4.f. ZIP Code 4.g. Province 4.h. Postal Code 4.i. Country [Deleted] [Deleted] [Deleted] Other Information 5. Alien Registration Number (A-Number) (if any) 6. U.S. Social Security Number (if any) 7. USCIS Online Account Number (if any) 8. Marital Status Single/Married/Divorced/Widowed [Page 2] 9. Gender Male Female 10. Date of Birth (mm/dd/yyyy) 11. Country of Birth 12. Country of Citizenship or Nationality 13. Form I-94 Arrival-Departure Record Number 14. Passport Number 15. Travel Document Number 16. Country of Issuance for Passport or Travel Document 17. Date of Issuance for Passport or Travel Document (mm/dd/yyyy) 18. Expiration Date for Passport or Travel Document (mm/dd/yyyy) Place and Date of Last Entry into the United States and Date Authorized Stay Expired 19.a. City or Town 19.b. State 20. Date of Last Entry into the United States (mm/dd/yyyy) 21. Date Authorized Stay Expired (mm/dd/yyyy) 22. Current Immigration Status
Page 2-3, Part 2. Additional Information	[Page 2] Answers to the questions below require explanations and supporting documentation. Attach relevant documents in support of your claims that you are a victim of criminal activity listed in the Immigration and Nationality Act (INA), section 101(a)(15)(U). You must also attach a personal narrative statement describing the criminal activity of which you were the victim. If you are only petitioning for U derivative status for a qualifying family member(s) subsequent to your (the principal petitioner) initial filing, evidence supporting the original petition is not required to be submitted with the new Form I-918. Attach additional sheets of paper as needed. Write your name and Alien Registration Number (A#), if any, at the top of each sheet and indicate the number of the item that refers to your answer. Include the Part and letter or number relating to the additional information you provided (example: Part 2, Z). Check “Yes” or “No” as appropriate to each of the following questions. 1. I am a victim of criminal activity listed in the INA at section 101(a)(15)(U). 2. I have suffered substantial physical or mental abuse as a result of having been a victim of this criminal activity. 3. I possess information concerning the criminal activity of which I was a victim. 4. I am submitting a certification from a certifying official on Form I-918 Supplement B, U Nonimmigrant Status Certification. 5. The crime of which I am a victim occurred in the United States (including Indian country and military installations) or violated the laws of the United States. 6. I am under the age of 16 years of age. 7. I want an Employment Authorization Document. 8. Have you ever been in immigration proceedings? If “Yes,” what type of proceedings? (Check all that apply.) Removal Date (mm/dd/yyyy) Exclusion Date (mm/dd/yyyy) Deportation Date (mm/dd/yyyy) Recission Date (mm/dd/yyyy) Judicial Date (mm/dd/yyyy) 9. List each date, place of entry and status under which you entered the United States during the five years preceding the filing of this petition. Date of Entry (mm/dd/yyyy) Place of Entry Status at Entry Date of Entry (mm/dd/yyyy) Place of Entry Status at Entry Date of Entry (mm/dd/yyyy) Place of Entry Status at Entry [Page 3] 10. If you are outside of the United States, provide the U.S. consulate or inspection facility you want notified if this petition is approved. Type of Office (check one) Consulate/Pre-flight inspection/ Port of Entry Office Address (City) U.S. State or Foreign Country Safe Foreign Address Where You Want Notifications Sent- Street Number and Name Apt. No. City State/Province Country Zip/Postal Code	[Page 2] Part 2. Additional Information About You Answering “Yes” to the following questions below requires explanations and supporting documentation. Attach relevant documents in support of your claims that you are a victim of criminal activity listed in the Immigration and Nationality Act (INA) section 101(a)(15)(U)(iii). You must also attach a personal narrative statement describing the criminal activity of which you are a victim. If you are only petitioning for U derivative status for qualifying family members subsequent to your (the principal petitioner) initial filing, you are not required to submit evidence supporting the original petition with the new Form I-918. If you need extra space to complete Part 2., use the space provided in Part 8. Additional Information. Select "Yes" or "No," as appropriate, for each of the following questions. 1. I am a victim of criminal activity listed in the INA at section 101(a)(15)(U)(iii). [No change] [No change] 4. I am submitting Form I-918, Supplement B, U Nonimmigrant Status Certification, from a certifying official. [No change] [No change] [Deleted] 7.a. I was or am in immigration proceedings. If you answered “Yes,” select the type of proceedings. If you were in proceedings in the past and are no longer in proceedings, provide the date of action. If you are currently in proceedings, type or print “Current” in the appropriate date field. Select all applicable boxes. Use the space provided in Part 8. Additional Information to provide an explanation. 7.b. Removal Proceedings Removal Date (mm/dd/yyyy) 7.c. Exclusion Proceedings Exclusion Date (mm/dd/yyyy) 7.d. Deportation Proceedings Deportation Date (mm/dd/yyyy) 7.e. Rescission Proceedings Rescission Date (mm/dd/yyyy) 7.f. Judicial Proceedings Judicial Date (mm/dd/yyyy) [Deleted item previously here] Provide the date of entry, place of entry, and status under which you entered the United States for each entry during the five years preceding the filing of this petition. 8.a. Date of Entry (mm/dd/yyyy) Place of Entry into the United States 8.b. City or Town 8.c. State 8.d. Status at the Time of Entry (for example, F-1 student, B-2 tourist, entered without inspection) 9.a. Date of Entry (mm/dd/yyyy) Place of Entry into the United States 9.b. City or Town 9.c. State 9.d. Status at the Time of Entry (for example, F-1 student, B-2 tourist, entered without inspection) 10.a. Date of Entry (mm/dd/yyyy) Place of Entry into the United States 10.b. City or Town 10.c. State 10.d. Status at the Time of Entry (for example, F-1 student, B-2 tourist, entered without inspection) If you are outside of the United States, provide the U.S. Consulate or inspection facility or a safe foreign mailing address you want notified if this petition is approved. 11.a. Type of Office (Select only one box): U.S. Consulate/Pre-Flight Inspection/ Port-of-Entry 11.b. City or Town 11.c. State 11.d. Country Safe Foreign Address Where You Want Notification Sent (if other than U.S. Consulate, Pre-Flight Inspection, or Port-of-Entry) 12.a. Street Number and Name 12.b. Apt. Ste. Flr. [Fillable Field] 12.c. City or Town 12.d. Province 12.e. Postal Code 12.f. Country
Page 3-7, Part 3. Processing information.	[Page 3] Part 3. Processing information. Please answer the following questions about yourself. For the purposes of this petition, you must answer “Yes” to the following questions, if applicable, even if your records were sealed or otherwise cleared or if anyone, including a judge, law enforcement officer or attorney, told you that you no longer have a record. (Answering “Yes” does not necessarily mean that you will be denied U nonimmigrant status.) 1. Have you EVER: a. Committed a crime or offense for which you have not been arrested? b. Been arrested, cited or detained by any law enforcement officer (including DHS, former INS and military officers) for any reason? c. Been charged with committing any crime or offense? d. Been convicted of a crime or offense (even if violation was subsequently expunged or pardoned)? e. Been placed in an alternative sentencing or a rehabilitative program (for example: diversion, deferred prosecution, withheld adjudication, deferred adjudication)? f. Received a suspended sentence, been placed on probation or been paroled? g. Been in jail or prison? h. Been the beneficiary of a pardon, amnesty, rehabilitation, or other act of clemency or similar action? i. Exercised diplomatic immunity to avoid prosecution for a criminal offense in the United States? If you answered “Yes” to any of the above questions, complete the following table. If you need more space, use a separate sheet of paper to give the same information. Why were you arrested, cited, detained or charged? Date of arrest, citation, detention, charge. (mm/dd/yyyy) Where were you arrested, cited, detained or charged? (City, State, Country) Outcome or disposition. (e.g., no charges filed, charges dismissed, jail, probation, etc.) Why were you arrested, cited, detained or charged? Date of arrest, citation, detention, charge. (mm/dd/yyyy) Where were you arrested, cited, detained or charged? (City, State, Country) Outcome or disposition. (e.g., no charges filed, charges dismissed, jail, probation, etc.) Why were you arrested, cited, detained or charged? Date of arrest, citation, detention, charge. (mm/dd/yyyy) Where were you arrested, cited, detained or charged? (City, State, Country) Outcome or disposition. (e.g., no charges filed, charges dismissed, jail, probation, etc.) [Page 4] 2. Have you ever received public assistance in the United States from any source, including the U.S. government or any State, county, city or other municipality (other than emergency medical treatment), or are you likely to receive public assistance in the future? 3. Have you: a. Engaged in prostitution or procurement of prostitution or do you intend to engage in prostitution or procurement of prostitution? b. Ever engaged in any unlawful commercialized vice, including, but not limited to illegal gambling? c. Ever knowingly encouraged, induced, assisted, abetted or aided any alien to try to enter the United States illegally? d. Ever illicitly trafficked in any controlled substance, or knowingly assisted, abetted or colluded in the illicit trafficking of any controlled substance? 4. Have you ever committed, planned or prepared, participated in, threatened to, attempted to, or conspired to commit, gathered information for, solicited funds for any of the following: a. Highjacking or sabotage of any conveyance (including an aircraft, vessel, or vehicle? b. Seizing or detaining, and threatening to kill, injure, or continue to detain, another individual in order to compel a third person (including a governmental organization) to do or abstain from doing any act as an explicit or implicit condition for the release of the individual seized or detained? c. Assassination? d. The use of any firearm with intent to endanger, directly or indirectly, the safety of one or more individual or to cause substantial damage to property? e. The use of any biological agent, chemical agent, or nuclear weapon or device, or explosive, or other weapon or dangerous device, with intent to endanger, directly or indirectly, the safety of one or more individuals or to cause substantial damage to property? 5. Have you ever been a member of, solicited money or members for, provided support for, attended military training (as defined in section 2339D(c)(1) of title 18, United States Code) by or on behalf of, or been associated with an organization that is: b. Any other group of two or more individuals, whether organized or not, which has engaged in or has a subgroup which has engaged in: a. Designated as a terrorist organization under section 219 of the Immigration and Nationality Act? c. Highjacking or sabotage of any conveyance (including an aircraft, vessel, or vehicle? d. Seizing or detaining, and threatening to kill, injure, or continue to detain, another individual in order to compel a third person (including a governmental organization) to do or abstain from doing any act as an explicit or implicit condition for the release of the individual seized or detained? e. Assassination? f. The use of any firearm with intent to endanger, directly or indirectly, the safety of one or more individual or to cause substantial damage to property? g. The use of any biological agent, chemical agent, or nuclear weapon or device, or explosive, or other weapon or dangerous device, with intent to endanger, directly or indirectly, the safety of one or more individuals or to cause substantial damage to property? h. Soliciting money or members or otherwise providing material support to a terrorist organization? 6. Do you intend to engage in the United States in: a. Espionage? b. Any unlawful activity, or any activity the purpose of which is in opposition to, or the control or overthrow of the government of the United States? c. Solely, principally, or incidentally in any activity related to espionage or sabotage or to violate any law involving the export of goods, technology, or sensitive information? 7. Have you ever been or do you continue to be a member of the Communist or other totalitarian party, except when membership was involuntary? 8. Have you, during the period of March 23, 1933 to May 8, 1945, in association with either the Nazi Government of Germany or any organization or government associated or allied with the Nazi Government of Germany, ever ordered, incited, assisted or otherwise participated in the persecution of any person because of race, religion, nationality, membership in a particular social group or political opinion? 9. Have you EVER ordered, committed, assisted, helped with, or otherwise participated in any act that involved: a. Torture or genocide? b. Killing, beating, or injuring any person? d. Engaging in any kind of sexual contact or relations with any person who was being subjected to force, threat of force, compulsion, or duress? e. Limiting or denying any person's ability to exercise religious beliefs? f. The persecution of any person because of race, religion, national origin, membership in a particular social group, or political opinion? c. Displacing or moving any persons from their residence by force, threat of force, compulsion, or duress? If you answer “Yes,” please describe the circumstances on a separate sheet(s) of paper. 10. Have you EVER advocated that another person commit any of the acts described in the preceding question, urged, or encouraged another person, to commit such acts? (If you answer “Yes,” describe the circumstances on a separate sheet(s) of paper.) [Page 6] 11. Have you EVER been present or nearby when any person was: a. Intentionally killed, tortured, beaten, or injured? b. Displaced or moved from his or her residence by force, compulsion or duress? c. In any way compelled or forced to engage in any kind of sexual contact or relations? If you answer “Yes,” please describe the circumstances on a separate sheet(s) of paper. 12. Have you (or has any member of your family) EVER served in, been a member of, or been involved in any way with: a. Any military unit, paramilitary unit, police unit, self-defense unit, vigilante unit, rebel group, guerrilla group, or insurgent organization? b. Any prison, jail, prison camp, detention camp, labor camp, or any other situation that involved guarding prisoners? c. Any group, unit, or organization of any kind in which you or other persons possessed, transported, or used any type of weapon? If you answer “Yes,” please describe the circumstances on a separate sheet(s) of paper. 13. Have your EVER received any type of military, paramilitary or weapons training? (If you answer “Yes,” please describe the circumstances on a separate sheet(s) of paper.) 14. a. Are removal, exclusion, rescission or deportation proceedings pending against you? b. Have removal, exclusion, rescission or deportation proceedings EVER been initiated against you? c. Have you EVER been removed, excluded or deported from the United States? d. Have you EVER been ordered to be removed, excluded or deported from the United States? e. Have you EVER been denied a visa or denied admission to the United States? (If a visa was denied, explain why on a separate sheet of paper.) f. Have you EVER been granted voluntary departure by an immigration officer or an immigration judge and failed to depart within the allotted time? 15. Are you under a final order or civil penalty for violating section 274C (producing and/or using false documentation to unlawfully satisfy a requirement of the Immigration and Nationality Act)? 16. Have you ever, by fraud or willful misrepresentation of a material fact, sought to procure, or procured, a visa or other documentation, for entry into the United States or any immigration benefit? 17. Have you ever left the United States to avoid being drafted into the U.S. Armed Forces? 18. Have you ever been a J nonimmigrant exchange visitor who was subject to the two-year foreign residence requirement and not yet complied with that requirement or obtained a waiver of such? 19. Have you ever detained, retained, or withheld the custody of a child, having a lawful claim to United States citizenship, outside the United States from a United States citizen granted custody? 20. Do you plan to practice polygamy in the United States? 21. Have you entered the United States as a stowaway? 22. a. Do you have a communicable disease of public health significance? b. Do you have or have you had a physical or mental disorder and behavior (or a history of behavior that is likely to recur) associated with the disorder which has posed or may pose a threat to the property, safety, or welfare of yourself or others? c. Are you now or have you been a drug abuser or drug addict?	[Page 3] Part 3. Processing Information Answer the following questions about yourself. For the purposes of this petition, you must answer “Yes” to the following questions, if applicable, even if your records were sealed or otherwise cleared or if anyone, including a judge, law enforcement officer, or attorney, told you that you no longer have a record. NOTE: If you answer “Yes” to ANY question in Part 3., provide an explanation in the space provided in Part 8. Additional Information. NOTE: Answering “Yes” does not necessarily mean that U.S. Citizenship and Immigration Services (USCIS) will deny your Petition for U Nonimmigrant Status. Have you EVER: 1.a. Committed a crime or offense for which you have not been arrested? 1.b. Been arrested, cited, or detained by any law enforcement officer (including Department of Homeland Security (DHS), former Immigration and Naturalization Service (INS), and military officers) for any reason? 1.c. Been charged with committing any crime or offense? 1.d. Been convicted of a crime or offense (even if the violation was subsequently expunged or pardoned)? 1.e. Been placed in an alternative sentencing or a rehabilitative program (for example, diversion, deferred prosecution, withheld adjudication, deferred adjudication)? 1.f. Received a suspended sentence, been placed on probation, or been paroled? 1.g. Been in jail or prison? 1.h. Been the beneficiary of a pardon, amnesty, rehabilitation, or other act of clemency or similar action? 1.i. Exercised diplomatic immunity to avoid prosecution for a criminal offense in the United States? Information About Arrests, Citations, Detentions, or Charges If you answered “Yes” to any of the above questions, respond to the questions below to provide additional details. If you need extra space, use the space provided in Part 8. Additional Information. 2.a Why were you arrested, cited, detained, or charged? 2.b. Date of arrest, citation, detention, or charge (mm/dd/yyyy) Where were you arrested, cited, detained, or charged? 2.c. City or Town 2.d. State 2.e. Country 2.f. Outcome or disposition (for example, no charges filed, charges dismissed, jail, probation) -------------- 3.a Why were you arrested, cited, detained, or charged? 3.b. Date of arrest, citation, detention, or charge (mm/dd/yyyy) Where were you arrested, cited, detained, or charged? 3.c. City or Town 3.d. State 3.e. Country 3.f. Outcome or disposition (for example, no charges filed, charges dismissed, jail, probation) [Deleted] [Deleted] [Deleted] [Deleted] [Deleted] Have you EVER: 4.a. Engaged in, or do you intend to engage in, prostitution or procurement of prostitution? 4.b. Engaged in any unlawful commercialized vice, including, but not limited to, illegal gambling? 4.c. Knowingly encouraged, induced, assisted, abetted, or aided any alien to try to enter the United States illegally? 4.d. Illicitly trafficked in any controlled substance or knowingly assisted, abetted, or colluded in the illicit trafficking of any controlled substance? Have you EVER committed, planned or prepared, participated in, threatened to, attempted to, conspired to commit, gathered information for, or solicited funds for any of the following: 5.a. Hijacking or sabotage of any conveyance (including an aircraft, vessel, or vehicle)? 5.b. Seizing or detaining, and threatening to kill, injure, or continue to detain, another individual in order to compel a third person (including a governmental organization) to do or abstain from doing any act as an explicit or implicit condition for the release of the individual seized or detained? 5.c. Assassination? 5.d. The use of any firearm with intent to endanger, directly or indirectly, the safety of one or more individuals or to cause substantial damage to property? 5.e. The use of any biological agent, chemical agent, nuclear weapon or device, explosive, or other weapon or dangerous device, with intent to endanger, directly or indirectly, the safety of one or more individuals or to cause substantial damage to property? Have you EVER been a member of, solicited money or members for, provided support for, attended military training (as defined in section 2339D(c)(1) of Title 18, United States Code) by or on behalf of, or been associated with any other group of two or more individuals, whether organized or not, which has been designated as, or has engaged in or has a subgroup which has been designated as, or has engaged in: 6.a. A terrorist organization under section 219 of the INA? 6.b. Hijacking or sabotage of any conveyance (including an aircraft, vessel, or vehicle)? 6.c. Seizing or detaining, and threatening to kill, injure, or continue to detain, another individual in order to compel a third person (including a governmental organization) to do or abstain from doing any act as an explicit or implicit condition for the release of the individual seized or detained? 6.d. Assassination? 6.e. The use of any firearm with intent to endanger, directly or indirectly, the safety of one or more individuals or to cause substantial damage to property? 6.f. The use of any biological agent, chemical agent, nuclear weapon or device, explosive, or other weapon or dangerous device, with intent to endanger, directly or indirectly, the safety of one or more individuals or to cause substantial damage to property? 6.g. Soliciting money or members or otherwise providing material support to a terrorist organization? Do you intend to engage in the United States in: 7.a. Espionage? 7.b. Any unlawful activity, or any activity the purpose of which is in opposition to, or the control, or overthrow of the government of the United States? 7.c. Solely, principally, or incidentally in any activity related to espionage or sabotage or to violate any law involving the export of goods, technology, or sensitive information? 8. Have you EVER been or do you continue to be a member of the Communist or other totalitarian party, except when membership was involuntary? 9. Have you EVER, during the period of March 23, 1933 to May 8, 1945, in association with either the Nazi Government of Germany or any organization or government associated or allied with the Nazi Government of Germany, ordered, incited, assisted or otherwise participated in the persecution of any person because of race, religion, nationality, membership in a particular social group, or political opinion? Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: 10.a. Acts involving torture or genocide? 10.b. Killing any person? 10.c. Intentionally and severely injuring any person? 10.d. Engaging in any kind of sexual conduct or relations with any person who was being forced or threatened? 10.e. Limiting or denying any person's ability to exercise religious beliefs? 10.f. The persecution of any person because of race, religion, national origin, membership in a particular social group, or political opinion? 10.g. Displacing or moving any person from their residence by force, threat of force, compulsion, or duress? NOTE: If you answered "Yes" to any question in Item Numbers 10.a - 10.g., please describe the circumstances in Part 8. Additional Information. 11. Have you EVER advocated that another person commit any of the acts described in the preceding question, urged, or encouraged another person, to commit such acts? Have you EVER been present or nearby when any person was: 12.a. Intentionally killed, tortured, beaten, or injured? 12.b. Displaced or moved from his or her residence by force, compulsion, or duress? 12.c. In any way compelled or forced to engage in any kind of sexual contact or relations? Have you EVER: 13.a. Served in, been a member of, assisted in, or participated in any military unit, paramilitary unit, police unit, self-defense unit, vigilante unit, rebel group, guerilla group, militia, or other insurgent organization? 13.b. Served in any prison, jail, prison camp, detention facility, labor camp, or any other situation that involved detaining persons? 13.c. Served in, been a member of, assisted in, or participated in any group, unit, or organization of any kind in which you or other persons transported, possessed, or used any type of weapon? NOTE: If you answered "Yes" to any question in Item Numbers 13.a - 13.c., please describe the circumstances in Part 8. Additional Information. Have you EVER: 14.a. Received any type of military, paramilitary, or weapons training? 14.b. Been a member of, assisted in, or participated in any group, unit, or organization of any kind in which you or other persons used any type of weapon against any person or threatened to do so? 14.c. Assisted or participated in selling or providing weapons to any person who to your knowledge used them against another person, or in transporting weapons to any person who to your knowledge used them against another person? NOTE: If you answered "Yes" to any question in Item Numbers 14.a - 14.c., please describe the circumstances in Part 8. Additional Information. Have you EVER: 15.a. Recruited, enlisted, conscripted, or used any person under 15 years of age to serve in or help an armed force or group? 15.b. Used any person under 15 years of age to take part in hostilities, or to help or provide services to people in combat? 16. Are you NOW in removal, exclusion, rescission, or deportation proceedings? 17. Have you EVER had removal, exclusion, rescission, or deportation proceedings initiated against you? 18. Have you EVER been removed, excluded, or deported from the United States? 19. Have you EVER been ordered to be removed, excluded, or deported from the United States? 20. Have you EVER been denied a visa or denied admission to the United States? 21. Have you EVER been granted voluntary departure by an immigration officer or an immigration judge and failed to depart within the allotted time? 22. Are you NOW under a final order or civil penalty for violating section 274C of the INA (producing and/or using false documentation to unlawfully satisfy a requirement of the INA)? 23. Have you EVER, by fraud or willful misrepresentation of a material fact, sought to procure or procured a visa or other documentation, for entry into the United States or any immigration benefit? 24. Have you EVER left the United States to avoid being drafted into the U.S. Armed Forces or U.S. Coast Guard? 25. Have you EVER been a J nonimmigrant exchange visitor who was subject to the 2-year foreign residence requirement and not yet complied with that requirement or obtained a waiver of such? 26. Have you EVER detained, retained, or withheld the custody of a child, having a lawful claim to United States citizenship, outside the United States from a United States citizen granted custody? 27. Do you plan to practice polygamy in the United States? 28. Have you EVER entered the United States as a stowaway? 29.a. Do you NOW have a communicable disease of public health significance? 29.b. Do you NOW have or have you EVER had a physical or mental disorder and behavior (or a history of behavior that is likely to recur) associated with the disorder which has posed or may pose a threat to the property, safety, or welfare of yourself or others? 29.c. Are you NOW or have you EVER been a drug abuser or drug addict?
Page 7, Part 4. Information about spouse and/or children and Page 8, Part 5. Filing on behalf of family members.	[Page 7] Part 4. Information about spouse and/or children 1. Spouse Family Name Given Name Middle Name Date of Birth (mm/dd/yyyy) Country of Birth Relationship Current Location 2. Children Family Name Given Name Middle Name Date of Birth (mm/dd/yyyy) Country of Birth Relationship Current Location Family Name Given Name Middle Name Date of Birth (mm/dd/yyyy) Country of Birth Relationship Current Location [Page 8] Part 5. Filing on behalf of family members. I am now petitioning for one or more qualifying family member(s). (If “Yes,” complete and include Form I-918, Supplement A and Supplement B, for each family member for whom you are petitioning.)	[Page 6] Part 4. Information About Your Spouse and/or Children If you need extra space to complete Part 4., use the space provided in Part 8. Additional Information. 1.a. Family Name (Last Name) 1.b. Given Name (First Name) 1.c. Middle Name 2. Date of Birth (mm/dd/yyyy) 3. Country of Birth 4. Relationship 5. Current Location 6.a. Family Name (Last Name) 6.b. Given Name (First Name) 6.c. Middle Name 7. Date of Birth (mm/dd/yyyy) 8. Country of Birth 9. Relationship 10. Current Location 11.a. Family Name (Last Name) 11.b. Given Name (First Name) 11.c. Middle Name 12. Date of Birth (mm/dd/yyyy) 13. Country of Birth 14. Relationship 15. Current Location 16.a. Family Name (Last Name) 16.b. Given Name (First Name) 16.c. Middle Name 17. Date of Birth (mm/dd/yyyy) 18. Country of Birth 19. Relationship 20. Current Location 21.a. Family Name (Last Name) 21.b. Given Name (First Name) 21.c. Middle Name 22. Date of Birth (mm/dd/yyyy) 23. Country of Birth 24. Relationship 25. Current Location Filing On Behalf of Family Members 26. I am petitioning for one or more qualifying family members. NOTE: NOTE: If you answered “Yes” to Item Number 26., you must complete and include Supplement A for each family member for whom you are petitioning.
Page 8, Part 6. Attestation, release and signature (Read the information on penalties in the instructions before completing this part.)	[Page 8] Part 6. Attestation, release and signature (Read the information on penalties in the instructions before completing this part.) I certify, under penalty of perjury under the laws of the United States of America, that the information provided with this petition is all true and correct. I certify also that I have not withheld any information that would affect the outcome of this petition. Signature Date (mm/dd/yyyy) NOTE: If you do not completely fill out this form or fail to submit required documents listed in the instructions, you may not be found eligible for the benefit sought and this petition will be denied.	[Page 7] Part 5. Petitioner’s Statement, Contact Information, Declaration, and Signature NOTE: Read the Penalties section of the Form I-918 Instructions before completing this part. Petitioner’s Statement NOTE: Select the box for either Item Number 1.a. or 1.b. If applicable, select the box for Item Number 2. 1.a. [] I can read and understand English, and I have read and understand every question and instruction on this petition and my answer to every question. 1.b. [] The interpreter named in Part 6. read to me every question and instruction on this petition and my answer to every question in [Fillable Field], a language in which I am fluent, and I understood everything. 2. [] At my request, the preparer named in Part 7., [Fillable Filed], prepared this petition for me based only upon information I provided or authorized. Petitioner’s Contact Information 3. Petitioner’s Daytime Telephone Number 4. Petitioner’s Mobile Telephone Number (if any) 5. Petitioner’s Email Address (if any) Petitioner’s Declaration and Certification Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any of my records that USCIS may need to determine my eligibility for the immigration benefit I seek. I further authorize release of information contained in this petition, in supporting documents, and in my USCIS records to other entities and persons where necessary for the administration and enforcement of U.S. immigration laws. I understand that USCIS may require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or signature) and, at that time, if I am required to provide biometrics, I will be required to sign an oath reaffirming that: 1) I provided or authorized all of the information contained in, and submitted with, my petition; 2) I reviewed and understood all of the information in, and submitted with, my petition; and 3) All of this information was complete, true, and correct at the time of filing. I certify, under penalty of perjury, that all of the information in my petition and any document submitted with it were provided or authorized by me, that I reviewed and understand all of the information contained in, and submitted with, my petition, and that all of this information is complete, true, and correct. Petitioner’s Signature 6.a. Petitioner’s Signature 6.b. Date of Signature (mm/dd/yyyy) NOTE TO ALL PETITIONERS: If you do not completely fill out this petition or fail to submit required documents listed in the Instructions, USCIS may deny your petition. NOTE: A parent or legal guardian may sign for a person who is less than 14 years of age. A legal guardian may sign for a mentally incompetent person.
		[Page 8] [New] Part 6. Interpreter’s Contact Information, Certification, and Signature Provide the following information about the interpreter. Interpreter’s Full Name 1.a. Interpreter’s Family Name (Last Name) 1.b. Interpreter’s Given Name (First Name) 2. Interpreter’s Business or Organization Name (if any) Interpreter’s Mailing Address 3.a. Street Number and Name 3.b. [ ] Apt. [ ] Ste. [ ] Flr. [fillable field] 3.c. City or Town 3.d. State 3.e. ZIP Code 3.f. Province 3.g. Postal Code 3.h. Country Interpreter’s Contact Information [Sub-header] 4. Interpreter’s Daytime Telephone Number 5. Interpreter’s Mobile Telephone Number (if any) 6. Interpreter’s Email Address (if any) Interpreter’s Certification I certify, under penalty of perjury, that: I am fluent in English and [Fillable Field], which is the same language specified in Part 5., Item Number 1.b., and I have read to this petitioner in the identified language every question and instruction on this petition and his or her answer to every question. The petitioner informed me that he or she understands every instruction, question, and answer on the petition, including the Petitioner’s Declaration and Certification, and has verified the accuracy of every answer. Interpreter’s Signature 7.a. Interpreter’s Signature 7.b. Date of Signature (mm/dd/yyyy)
Page 8, Part 7. Signature of person preparing form, if other than above (Sign below.)	[Page 8] Part 7. Signature of person preparing form, if other than above (Sign below.) Preparer’s Printed Name Preparer’s Firm Name (if applicable) Preparer’s Address Daytime Phone Number (with area code) Fax Number (if any) E-Mail Address (if any) I declare that I prepared this petition at the request of the above person, and it is based on all information of which I have knowledge. I have not knowingly withheld any material information that would affect the outcome of this petition. Attorney or Representative: In the event of a Request for Evidence, may USCIS contact you by Fax or E-Mail? Preparer’s Signature Date (mm/dd/yyyy)	[Page 9] Part 7. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner Provide the following information about the preparer. Preparer’s Full Name 1.a. Preparer’s Family Name (Last Name) 1.b. Preparer’s Given Name (First Name) 2. Preparer’s Business or Organization Name (if any) Preparer’s Mailing Address 3.a. Street Number and Name 3.b. [ ] Apt. [ ] Ste. [ ] Flr. [fillable field] 3.c. City or Town 3.d. State 3.e. ZIP Code 3.f. Province 3.g. Postal Code 3.h. Country Preparer’s Contact Information 4. Preparer’s Daytime Telephone Number 5. Preparer’s Mobile Telephone Number (if any) 6. Preparer’s Email Address (if any) Preparer’s Statement 7.a. [] I am not an attorney or accredited representative but have prepared this petition on behalf of the petitioner and with the petitioner’s consent. 7.b. [] I am an attorney or accredited representative and my representation of the petitioner in this case [] extends [] does not extend beyond the preparation of this petition. NOTE: If you are an attorney or accredited representative whose representation extends beyond preparation of this petition, you may be obliged to submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, with this petition. Preparer’s Certification By my signature, I certify, under penalty of perjury, that I prepared this petition at the request of the petitioner. The petitioner then reviewed this completed petition and informed me that he or she understands all of the information contained in, and submitted with, his or her petition, including the Petitioner’s Declaration and Certification, and that all of this information is complete, true, and correct. I completed this petition based only on information that the petitioner provided to me or authorized me to obtain or use. [Deleted] Preparer’s Signature [Sub-header] 8.a. Preparer’s Signature 8.b. Date of Signature (mm/dd/yyyy)
		[Page 11] [New] Part 8. Additional Information If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Include your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet. 1.a. Family Name (Last Name) 1.b. Given Name (First Name) 1.c. Middle Name 2. A-Number (if any) 3.a. Page Number 3.b. Part Number 3.c. Item Number 3.d. [Fillable Field] 4.a. Page Number 4.b. Part Number 4.c. Item Number 4.d. [Fillable Field] 5.a. Page Number 5.b. Part Number 5.c. Item Number 5.d. [Fillable Field] 6.a. Page Number 6.b. Part Number 6.c. Item Number 6.d. [Fillable Field] 7.a. Page Number 7.b. Part Number 7.c. Item Number 7.d. [Fillable Field]

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