Form I-914 Application for T Nonimmigrant Status; Application for I

USCIS
Form I-914

Application for T Nonimmigrant Status
Department of Homeland Security
U.S. Citizenship and Immigration Services

OMB No. 1615-0099
Expires 02/28/2026

START HERE - Type or print in ink.

For USCIS Use Only

Part 1. Purpose for Filing This Application
Select all applicable boxes.

Date

1.

Date

A.
B.

Receipt

Returned

I am filing for T-1 nonimmigrant status and have not previously filed for
such status.

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I am filing for T-1 nonimmigrant status and have previously filed for
such status. (Provide receipt number below.)
(1)

Resubmitted

Date
Date

Receipt Number EAC

Reloc Sent

Part 2. General Information About You (Person filing this application as a victim)

Date
Date

1.

Your Full Legal Name

Family Name (Last Name)

Given Name (First Name)

Middle Name (if any)

Reloc Rec'd

Date

2.

Date

Other Names Used

Provide any other names you have used since birth, including aliases, maiden
names, and nicknames. If you need extra space to complete this section, use the
space provided in Part 9. Additional Information.
Family Name (Last Name)

3.

Given Name (First Name)

Remarks

Middle Name (if any)

Physical Address

Street Number and Name

Validity Dates
From: ____________________________
To: ______________________________

(USPS ZIP Code Lookup)

Waitlisted

Apt. Ste. Flr. Number

Stamp #

City or Town

4.

State

ZIP Code

Date

Action Block

Safe Mailing Address
If you do not want U.S. Citizenship and Immigration Services (USCIS) to send
notices about this application to your home address, you may provide an alternate
safe mailing address.
In Care Of Name

Street Number and Name

Apt. Ste. Flr. Number

To be fully completed by an attorney or
accredited representative, if any.
Select this box if Form G-28 is attached.

City or Town

State

ZIP Code

Attorney State License Bar Number

Attorney or Accredited Representative
USCIS Online Account Number

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Part 2. General Information About You (Person filing this application as a victim) (continued)
5.

Alien Registration Number (A-Number) (if any)
► A-

6.

USCIS Online Account Number (if any)
►

7.

U.S. Social Security Number (SSN) (if any)
►

8.

Gender

9.

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Female

Marital Status

Single/Never Married
11.

Male

Another Gender Identity

10.

Married

Divorced

Date of Birth (dd/mm/yyyy)

Widowed

Place of Birth
City or Town

State or Province

Country

12.

Country of Citizenship or Nationality

13.

Passport or Travel Document Number (if any)

14.

Country That Issued Your Passport or Travel Document (if any)

15.

Issue Date for Passport or Travel Document (if any)
(mm/dd/yyyy)

16.

Expiration Date for Passport or Travel Document (if any)
(mm/dd/yyyy)

17.

Place of Your Last Entry Into the United States
City or Town

18.

Date of Your Last Entry Into the United States, On or About

State

19.

(mm/dd/yyyy)
20.

Form I-94 Arrival-Departure Record Number (if any)
►

Your Current Nonimmigrant Status

Part 3. Additional Information About Your Application
Answers to the following questions about your claim require explanation and supporting documentation. You should attach
documents in support of your claim that you are a victim of a severe form of trafficking in persons and the specific facts on which you
are relying to support your claim. If you answer “Yes” to Item Numbers 1. - 4., attach evidence and documents to support your
claim. You must attach a signed personal narrative statement addressing the eligibility requirements for T nonimmigrant status as
listed in the regulations, including a description of the trafficking you experienced. If you need extra space to complete this section,
use the space provided in Part 9. Additional Information.
1.

I am or have been a victim of a severe form of trafficking in persons.

Yes

No

2.

A.

I have cooperated with reasonable requests for assistance from law enforcement.

Yes

No

B.

Due to my age or the trauma I have suffered, I am exempt from the requirement to cooperate with
reasonable requests for assistance from law enforcement.

Yes

No

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Part 3. Additional Information About Your Application (continued)
3.

I am physically present in the United States, American Samoa, or the Commonwealth of the Northern
Mariana Islands, or at a port of entry, on account of trafficking, or have been allowed entry into the United
States to participate in investigative or judicial processes associated with an act or perpetrator of trafficking.

Yes

No

4.

I fear that I will suffer extreme hardship involving unusual and severe harm upon removal.

Yes

No

5.

I have reported the trafficking crime of which I am claiming to be a victim. (If you selected “Yes,” indicate
to which law enforcement agency and office you have made the report, the address and phone number of that
office, and the case number assigned, if any. If you selected “No,” explain the circumstances below.)

Yes

No

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Law Enforcement Agency and Office
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Daytime Telephone Number

ZIP Code

Case Number

Circumstances

6.

I was under 18 years of age at the time at least one of the acts of trafficking occurred.

Yes

No

7.

I have complied with reasonable requests from Federal, State, Tribal, or local law enforcement authorities for
assistance in the investigation or prosecution of acts of trafficking, or am unable to cooperate with such
requests due to physical or psychological trauma. (If you selected “No,” and were over 18 years of age at the
time one of the acts of trafficking occurred, explain the circumstances.)

Yes

No

8.

This is the first time I have entered the United States. (If you selected “No,” list each date, place of entry,
and under which status you entered the United States for the past five years, and explain the circumstances of
your most recent arrival.) If you need extra space, use the space provided in Part 9. Additional
Information.

Yes

No

(1)

Date of Entry (mm/dd/yyyy)

(2)

Place of Entry
City or Town

(3)

State

Status

9.

My most recent entry was on account of the trafficking that forms the basis for my claim. (Explain the
circumstances of your most recent arrival.)

Yes

No

10.

I am requesting an Employment Authorization Document (EAD) when I am granted T nonimmigrant status.

Yes

No

11.

I am now applying for one or more eligible family members. (If you selected “Yes,” complete and include a
Form I-914, Supplement A, Application for Derivative T Nonimmigrant Status, for each family member for
whom you are now applying. You may also apply to bring eligible family members to the United States at a
later date.)

Yes

No

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Part 4. Processing Information
Answer the following questions about yourself. Responses are intended to cover any activity you have committed under your legal
name or any aliases. For purposes of this application, you must answer “Yes” to the following questions, 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. (If your answer is "Yes" to any one of these questions, explain in the space provided in Part 9. Additional Information.
Additionally, explain if any of the acts or circumstances below are related to you having been a victim of a severe form of trafficking.
Answering "Yes" does not necessarily mean that you will be denied T nonimmigrant status or are not entitled to adjust your status or
register for permanent residence.)
1.

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Have you EVER:
A.
B.

C.
D.
E.
F.
G.
H.
I.

Committed a crime or offense for which you have not been arrested?

Yes

No

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?

Yes

No

Been charged with committing any crime or offense?

Yes

No

Been convicted of a crime or offense (even if violation was subsequently expunged or pardoned)?

Yes

No

Been placed in an alternative sentencing or a rehabilitative program (for example: diversion, deferred
prosecution, withheld adjudication, deferred adjudication)?

Yes

No

Received a suspended sentence, been placed on probation, or been paroled?

Yes

No

Been in jail or prison?

Yes

No

Been the beneficiary of a pardon, amnesty, rehabilitation, or other act of clemency or similar action?

Yes

No

Exercised diplomatic immunity to avoid prosecution for a criminal offense in the United States?

Yes

No

If you answered “Yes” to any of the above questions, complete the following table. If you need extra
space, use the space provided in Part 9. Additional Information.

Why were you arrested, cited,
detained, or charged?

2.

Date of arrest,
Where were you arrested,
citation, detention, cited, detained, or charged?
charge
(City or Town, State,
(mm/dd/yyyy)
Country)

Outcome or disposition
(for example, no charges
filed, charges dismissed,
jail, probation, etc.)

Have you:
A.

Engaged in prostitution or procurement of prostitution or do you intend to engage in prostitution or
procurement of prostitution?

Yes

No

B.

EVER engaged in any unlawful commercialized vice, including, but not limited to illegal gambling?

Yes

No

C.

EVER knowingly encouraged, induced, assisted, abetted, or aided any alien to try to enter the United
States illegally?

Yes

No

D.

EVER illicitly trafficked in any controlled substance, or knowingly assisted, abetted, or colluded in
the illicit trafficking of any controlled substance?

Yes

No

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Part 4. Processing Information (continued)
3.

Have you EVER committed, planned or prepared, participated in, threatened to, attempted to, or conspired to commit, gathered
information for, or solicited funds for any of the following:
A.

Hijacking or sabotage of any conveyance (including an aircraft, vessel, or vehicle)?

Yes

No

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?

Yes

No

Assassination?

Yes

No

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?

Yes

No

The use of any biological agent; chemical agent; or 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?

Yes

No

C.
D.
E.

4.

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:
A.
B.

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Designated as a terrorist organization under the Immigration and Nationality Act section 219?

Yes

No

Any other group of two or more individuals, whether organized or not, which has engaged in or has a
subgroup which has engaged in:
(1)

Hijacking or sabotage of any conveyance (including an aircraft, vessel, or vehicle)?

Yes

No

(2)

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?

Yes

No

(3)

Assassination?

Yes

No

(4)

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?

Yes

No

(5)

Soliciting money or members or otherwise providing material support to a terrorist organization?

Yes

No

(6)

The use of any biological agent; chemical agent; or 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?

Yes

No

Do you intend to engage in the United States in:
A.

Espionage?

Yes

No

B.

Any unlawful activity, or any activity the purpose of which is in opposition, to control, or overthrow
of the government of the United States?

Yes

No

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?

Yes

No

6.

Have you ever been or do you continue to be a member of the Communist or other totalitarian party, except
when membership was involuntary?

Yes

No

7.

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?

Yes

No

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Part 4. Processing Information (continued)
8.

Have you EVER been present or nearby when any person was:
A.

Intentionally killed, tortured, beaten, or injured?

Yes

No

B.

Displaced or moved from their residence by force, compulsion, or duress?

Yes

No

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C.
9.

A.
B.
C.
D.
E.
F.

10.

Yes

No

Are removal, exclusion, rescission, or deportation proceedings pending against you?

Yes

No

Have removal, exclusion, rescission, or deportation proceedings EVER been initiated against you?

Yes

No

Have you EVER been removed, excluded, or deported from the United States?

Yes

No

Have you EVER been ordered to be removed, excluded, or deported from the United States?

Yes

No

Have you EVER been denied a visa or denied admission to the United States? (If a visa was denied,
use the space provided in Part 9. Additional Information.)

Yes

No

Have you EVER been granted voluntary departure by an immigration officer or an immigration
judge and failed to depart within the allotted time?

Yes

No

Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following:
A.
B.
C.
D.
E.

11.

In any way compelled or forced to engage in any kind of sexual contact or relations?

Acts involving torture or genocide?

Yes

No

Killing any person?

Yes

No

Intentionally and severely injuring any person?

Yes

No

Engaging in any kind of sexual contact or relations with any person who was being forced or
threatened?

Yes

No

Limiting or denying any person's ability to exercise religious beliefs?

Yes

No

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, guerrilla group, militia, or insurgent organization?

Yes

No

Served in any prison, jail, prison camp, detention facility, labor camp, or any other situation that
involved detaining persons?

Yes

No

Have you EVER:
A.
B.

12.

Have you EVER 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?

Yes

No

13.

Have you EVER 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?

Yes

No

14.

Have you EVER received any type of military, paramilitary, or weapons training?

Yes

No

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)?

Yes

No

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?

Yes

No

17.

Have you EVER left the United States to avoid being drafted into the U.S. Armed Forces?

Yes

No

18.

Have you EVER detained, retained, or withheld the custody of a child, having a lawful claim to U.S.
citizenship, outside the United States from a U.S. citizen granted custody?

Yes

No

19.

Do you plan to practice polygamy in the United States?

Yes

No

20.

Have you entered the United States as a stowaway?

Yes

No

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Part 4. Processing Information (continued)
21.

A.

Do you have a communicable disease of public health significance?

Yes

No

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?

Yes

No

C.

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Are you now or have you been a drug abuser or drug addict?

Yes

No

Part 5. Information About Your Family Members

Provide the following information about your spouse and all of your children, if applicable. If you need extra space to complete this
section, use the space provided in Part 9. Additional Information.
1.

Information About your Spouse
A.

B.

D.

Family Name (Last Name)

Date of Birth (mm/dd/yyyy)

Given Name (First Name)

C.

Country of Birth

Current Location

City or Town of Residence

2.

Middle Name (if any)

Country of Residence

Information About Your Children
A.

Child 1

Family Name (Last Name)

Date of Birth (mm/dd/yyyy)

Given Name (First Name)

Middle Name (if any)

Country of Birth

Current Location
City or Town

B.

State

Country

Child 2
Family Name (Last Name)

Date of Birth (mm/dd/yyyy)

Given Name (First Name)

Middle Name (if any)

Country of Birth

Current Location
City or Town

Form I-914 Edition 04/01/24

State

Country

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Part 5. Information About Your Family Members (continued)
C.

Child 3
Family Name (Last Name)

Given Name (First Name)

Middle Name (if any)

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Date of Birth (mm/dd/yyyy)

Country of Birth

Current Location

City or Town

State

Country

Part 6. Applicant's Statement, Contact Information, Declaration, Certification, and Signature
NOTE: Read the Penalties section of the Form I-914 Instructions before completing this section.

Applicant's Statement

NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.
1.

Applicant's Statement Regarding the Interpreter
A.
B.

I can read and understand English, and I have read and understand every question and instruction on this application
and my answer to every question.
The interpreter named in Part 7. read to me every question and instruction on this application and my answer to every
question in
,
a language in which I am fluent, and I understood everything.

2.

Applicant's Statement Regarding the Preparer

At my request, the preparer named in Part 8.,
prepared this application for me based only upon information I provided or authorized.

,

Applicant's Contact Information
3.

Applicant's Daytime Telephone Number

5.

Applicant's Email Address (if any)

Form I-914 Edition 04/01/24

4.

Applicant's Safe Daytime Telephone Number

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Part 6. Applicant's Statement, Contact Information, Declaration, Certification, and Signature (continued)
Applicant'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
and all of my records that USCIS may need to determine my eligibility for the immigration benefit that I seek.

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I authorize the release of any information from my record that USCIS needs to determine eligibility for the benefit I am seeking to
investigate my claim, and to investigate fraudulent claims. I further authorize USCIS to release information to law enforcement
agencies and prosecutors investigating crimes of trafficking or related crimes. I further authorize USCIS to release information to
Federal, State, and local public and private agencies providing benefits, to be used solely in making determinations of eligibility for
benefits pursuant to 8 U.S.C. 1641(c).
I furthermore authorize release of information contained in this application, in supporting documents, and in my USCIS records, to
other entities and persons where necessary for the administration and enforcement of U.S. immigration law. Any disclosure will be in
accordance with the confidentiality provisions at 8 U.S.C. section 1367 and 8 CFR 214.216.
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)
2)

I reviewed and understood all the information contained in, and submitted with, my application; and
All of this information was complete, true, and correct at the time of filing.

I certify, under penalty of perjury, that all the information in my application and any document submitted with it were provided or
authorized by me, that I reviewed and understand all the information contained in, and submitted with, my application and that all this
information is complete, true, and correct.

Applicant's Signature
6.

Applicant's Signature

Date of Signature (mm/dd/yyyy)

NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the
Instructions, USCIS may deny your application.

Part 7. Interpreter's Contact Information, Certification, and Signature (if any)
Provide the following information about the interpreter.

Interpreter's Full Name
1.

Interpreter's Family Name (Last Name)

2.

Interpreter's Business or Organization Name (if any)

Form I-914 Edition 04/01/24

Interpreter's Given Name (First Name)

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Part 7. Interpreter's Contact Information, Certification, and Signature (if any) (continued)
Interpreter's Mailing Address
3.

Street Number and Name

Apt. Ste. Flr. Number

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City or Town

Province

State

Postal Code

ZIP Code

Country

Interpreter's Contact Information
4.

Interpreter's Daytime Telephone Number

6.

Interpreter's Email Address (if any)

5.

Interpreter's Mobile Telephone Number (if any)

Interpreter's Certification

I certify, under penalty of perjury, that:

I am fluent in English and
, which is the same language specified in Part 6., Item B. in
Item Number 1., and I have read to this applicant in the identified language every question and instruction on this application and
their answer to every question. The applicant informed me that they understand every instruction, question, and answer on the
application, including the Applicant's Declaration and Certification, and has verified the accuracy of every answer.

Interpreter's Signature
7.

Interpreter's Signature

Date of Signature (mm/dd/yyyy)

Part 8. Contact Information, Declaration, and Signature of the Person Preparing this Application, if
Other Than the Applicant
Provide the following information about the preparer.

Preparer's Full Name
1.

Preparer's Family Name (Last Name)

2.

Preparer's Business or Organization Name (if any)

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Preparer's Given Name (First Name)

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Part 8. Contact Information, Declaration, and Signature of the Person Preparing this Application, if
Other Than the Applicant (continued)
Preparer's Mailing Address
3.

Street Number and Name

Apt. Ste. Flr. Number

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City or Town

Province

State

Postal Code

ZIP Code

Country

Preparer's Contact Information
4.

Preparer's Daytime Telephone Number

6.

Preparer's Email Address (if any)

5.

Preparer's Mobile Telephone Number (if any)

Preparer's Statement
7.

A.
B.

I am not an attorney or accredited representative but have prepared this application on behalf of
the applicant and with the applicant's consent.
I am an attorney or accredited representative and my representation of the applicant in this case
does not extend beyond the preparation of this application.
extends

NOTE: If you are an attorney or accredited representative, you may be obliged to submit a completed Form G-28,
Notice of Entry of Appearance as Attorney or Accredited Representative, with this application.

Preparer's Certification
By my signature, I certify, under penalty of perjury, that I prepared this application at the request of the applicant. The applicant then
reviewed this completed application and informed me that they understand all the information contained in, and submitted with, their
application, including the Applicant's Declaration and Certification, and that all of this information is complete, true, and correct. I
completed this application based only on information that the applicant provided to me or authorized me to obtain or use.

Preparer's Signature
8.

Preparer's Signature

Form I-914 Edition 04/01/24

Date of Signature (mm/dd/yyyy)

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Part 9. 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.
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.

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1.

Family Name (Last Name)

2.

A-Number ► A-

3.

A.

D.

4.

A.

D.

5.

A.

Given Name (First Name)

Page Number

B.

Part Number C.

Item Number

Page Number

B.

Part Number C.

Item Number

Page Number

B.

Part Number C.

Item Number

Page Number

B.

Part Number C.

Item Number

Middle Name

D.

6.

A.

D.

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