Email Address  (required)



Full Name:

Address 

Date of birth 

Country of birth 

Social security number 

Alien registration number (if any) 

Date of last arrival

I-94 number 

Current INS status 

Date status expires

City/Town/Village of birth 

Current occupation 

Your mother's first name 

Your father's first name 

Your name exactly how it appears on your I-94

Place of last entry into U.S. (city and state) 

Were you inspected by an Immigration Officer 

In what status did you last enter the U.S. 

Non-immigrant visa number (shown on the visa in passport, generally in red, on the lower right-hand side) 

Consulate where visa was issued 

Date visa was issued

Sex 

Marital status 

Have you ever before applied for permanent residence status in the U.S.?

    -If yes, give date and place of filing and final disposition
 
List your present husband/wife, and all sons and daughters (including date of birth, country of birth, relationship, and whether he/she is applying with you
 
List present and past memberships and/or affiliations (including political and military) since your 16th birthday (in the U.S. or foreign) 
 
List all times you entered the U.S., and list the visa status of each entry