Pages 1-2,
Part 1. Information
About You
|
[Page 1]
…
B. Provide the reason for a
difference in the names, if any (marriage, divorce, etc.)
…
[Page 2]
8. Alien Registration Number
(A-Number) (if any)
9. U.S. Social Security
Number (if any)
…
17. List absences from the
United States since becoming a temporary resident. List the most
recent absence first. If you have a single absence that exceeded
30 days or if the total of all of your absences exceeds 90
days, explain using the space provided in Part 8.
Additional Information or attach a separate sheet of paper.
Type or print your name and A-Number (if any) at the top of the
sheet; indicate the Page Number, Part Number, and
Item Number to which your answer refers; and sign and date
each sheet.
…
|
[Page 1]
…
B. Provide the reason for a
difference in the names (marriage,
divorce, etc.)
…
[Page 2]
8. Alien Registration Number
(A-Number)
9. U.S. Social Security
Number
…
17. List absences from the
United States since becoming a temporary resident. List the most
recent absence first. If you have a single absence that exceeded
30 days or if the total of all of your absences exceeds 90
days, explain using the space provided in Part 8.
Additional Information or attach a separate sheet of paper.
Type or print your name and A-Number at the
top of the sheet; indicate the Page Number, Part Number,
and Item Number to which your answer refers; and sign and
date each sheet.
…
|
Pages 3-5,
Part 3. Eligibility
Standards
|
[Page 3]
…
Answer Item Numbers 2. - 29.
If you answer "Yes" to any of the questions, provide a
complete explanation using the space provided in Part 8.
Additional Information or attach a separate sheet of paper.
Type or print 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. Answering "Yes" does not necessarily mean
that you are not entitled to adjust status or register for lawful
permanent residence.
…
|
[Page 3]
…
Answer Item Numbers 2. - 29.
If you answer "Yes" to any of the questions, provide a
complete explanation using the space provided in Part 8.
Additional Information or attach a separate sheet of paper.
Type or print your name and A-Number 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. Answering "Yes" does not
necessarily mean that you are not entitled to adjust status or
register for lawful permanent residence.
…
|
Page 9,
Part 8. Additional
Information
|
[Page 9]
Part 8. Additional Information
If you need
extra space to provide any additional information within this
application, 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 application 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.
…
2. A-Number (if any)
…
|
[Page 9]
Part 8. Additional Information
If you need extra space to provide
any additional information within this application, 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 application or
attach a separate sheet of paper. Include your name and A-Number
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.
…
2. A-Number
…
|