Email Address (required)


Your Name (the person applying for Naturalization)


	

		
Your current legal name.

		
Your name exactly as it appears on your Permanent Resident Card.

		
If you have ever used other names, provide them below.

		
Name change (optional)

		If ''Yes," print the new name you would like to use. Do not use initials or abbreviations when writing your new name.

		
	


	
Information About Your Eligibility (Select Only One)

	I am at least 18 years old AND

	

		
 I have been a Lawful Permanent Resident of the United States for at least 5 years. 
		
 I have been a Lawful Permanent Resident of the United States for at least 3 years, AND I have been married to and living with the same U.S. citizen for the last 3 years, AND my spouse has been a U.S. citizen for the last 3 years. 
		
 I am applying on the basis of qualifying military service. 
		
 Other (Please explain)
		

	


	
Information About You


	

		
Social Security Number 

		
Date of Birth (Month/Day/Year) 

		
Date you became a permanent resident 
 
		
Country of Birth 

		
Country of Nationality 

		
Are either of your parents U.S. citizens? 

		     Yes 
		     No 
		
What is your current marital status: 

		     Single, Never Married

		     Married
      Divorced 

		     Widowed  
    Marriage Annulled or Other (Explain)

		    
		

		Are you requesting an accommodation to the naturalization process because of a disability or impairment? 

		If 'Yes", check the one below that applies:

		 I am deaf or hearing impaired and need a sign language interpreter who uses the following language: 

		

		 I use a wheelchair.

		 I am blind or sight impaired.

		 I will need another type of accommodation. Please explain:

		
		
	


	
Addresses and Telephone Numbers


	

		

		Home Address - Street Number and Name (Do NOT write a P.O. Box in this space)


		Apartment Number City


		County 


		State


		Zip Code


		Country 

		

		

		Care of - Mailing Address - Street Number and Name (if different from home address) 


		Apartment Number


		City


		Count


		State


		Zip Code


		Country 

		
		
		

		Daytime Phone Number (If any)


		Evening Phone Number (If any)


		E-mail Address (If any)

		
 
	


	
Information for Criminal Records Search


	

		
Gender:  Male  Female
		
Height:  Feet  Inches
		
Weight:  Pounds
		
Race (Select one or more): 
			

			    White  
			    Asian or Pacific Islander  
			    Black 

			    American Indian or Alaskan Native 
			    Unknown 
		
Hair color: 
    Black  
						    Brown  
						    Blonde  

						    Gray  
						    White  
						    Red  
						    Sandy  
						    Bald (No Hair)
		
Eye color: 	

						    Brown  
						    Blue  
						    Green  
						    Hazel  

						    Gray  
						    Black  
						    Pink  
						    Maroon  

						    Other 
	
	
Information for Criminal Records Search

	
	
		
Where have you lived during the last 5 years? 
		Begin with where you live now and then list every place
		you lived for the last 5 years.



		Street Number and Name,  Apartment Number
		City, State, Zip Code, Country,  Dates: From To 
		
 
		
		
Where have you worked (or if you were a student, what schools did you attend) during the last 5 years? Include military service.
		Begin with your current or latest employer and then list every place you have worked or studied for the last 5 years.
		


		Employer or School Name ,  Address ,  Occupation,  From To 
		

	
	
		
Time Outside the United States

		(Including Trips to Canada, Mexico, and the Caribbean Islands)
		

		

		
How many total days did you spend outside of the United States during the past 5 years? 
		

		
How many trips of 24 hours or more have you taken outside of the United States during the past 5 years? 
		

		
List below all the trips of 24 hours or more that you have taken outside of the United States since becoming a Lawful Permanent Resident. Begin with your most recent trip. 
		


		
		    Date you left the U.S.(month/day/year) 

	  	    Date you returned to the U.S. (month/day/year)

	   	    Did your trip last 6 months or more?

	   	    Countries to which you  traveled

		    Total days out of U.S.

		
		
		
Information About Your Marital History

		

		
How many times have you been married (including annulled marriages)? 

		
If you are married, give the following information about your spouse: 

    -Spouse's last name 

    -Spouse's first name 

    -Spouse's full middle name (if applicable) 

    -Date of birth (month/day/year) 

    -Date of marriage (month/day/year) 

    -Spouse's Social Security Number 

    -Home Address - Street Number and Name 

    -Apartment number 

    -City 

    -State 

    -Zip code



		
Is your spouse a U.S. citizen? 

		
If your spouse is a U.S. citizen, give the following information: 

		

		
When did your spouse become a U.S. citizen? at birth  or other

		
If "Other", give the following information: 
		
Date your spouse became a U.S. citizen 
		
Place your spouse became a U.S. citizen (city & state) 
		
		
		
If your spouse is NOT a U.S. citizen, give the following information: 
		

			
Spouse's country of citizenship
 
			
Spouse's INS "A" number (if applicable) 
			
Spouse's Immigration Status: Lawful Permanent Resident or Other 
		
		
		
		

		If you were married before, provide the following information about your prior spouse(s). (If you have more than one previous marriage, use a separate sheet of paper to list the information): 

		    Prior Spouse's last name, First name, Middle name(If applicable)
 
		    Prior Spouse's Immigration Status: U.S. citizen or Lawful Permanent Resident or Other 

		    Date of Marriage (Month/Day/Year) 

		    Date Marriage Ended (Month/Day/Year) 

		    How Marriage Ended: Divorce or Spouse died or Other 

		
		
		

		How many times has your current spouse been married (including annulled marriages)? 

		If your spouse has EVER been married before, give the following information about your spouse's prior marriage. (If your spouse has more than one previous marriage, use a separate sheet of paper to list the information): 

		    Current Spouse's last name, First name, Middle name (If applicable)

		    Current Spouse's Immigration Status: 

		    Date of Marriage (Month/Day/Year) 

		    Date Marriage Ended (Month/Day/Year) 

		
		
	


	
	
Information About Your Children

	

	
How many sons and daughters have you had? 
	
Provide the following information about all of your sons and daughters. 
	

	    Full name of son or daughter	

	    Date of birth (month/day/year) 

	    INS "A" number 

	    If child has one Country of birth Current Address(street/ city state country)

	
	
Additional Questions

	Please answer questions 1 through 14. If you answer ''Yes'' to any of these questions, include a written explanation with this form. Your written explanation should (1) explain why your answer was ''Yes,'' and (2) provide any additional information that helps to explain your answer.
	

	
General Questions 
		

		
Have you EVER claimed to be a U.S. citizen (in writing or any other way)? 
		
 Yes  No
		
Have you EVER registered to vote in any Federal, state, or local election in the United States?
		
 Yes  No
		
Have you EVER voted in any Federal, state, or local election in the United States?
		
 Yes  No
		
Since becoming a Lawful Permanent Resident, have you EVER failed to file a required Federal, state, or local tax return? 
		
 Yes  No
		
Do you owe any Federal, state, or local taxes that are overdue?
		
 Yes  No
		
Do you have any title of nobility in any foreign country?
		
 Yes  No
		
Have you ever been declared legally incompetent or been confined to a mental institution within the last 5 years?
		
 Yes  No
		
	
	
Affiliations 
		

		


		

		
Have you EVER been a member of or associated with any organization, association, fund, foundation, party, club, society, or similar group in the United States or in any other place?
		
 Yes  No
		
If you answered ''Yes,'' list the name of each group below. 
		

		
		
		
		
Have you EVER been a member of or in any way associated (either directly or indirectly) with: 

		

		
The Communist Party?
		
 Yes  No
		
Any other totalitarian party?
		
 Yes  No
		
A terrorist organization?
		
 Yes  No
		
		
		
Have you EVER advocated (either directly or indirectly) the overthrow of any government by force or violence?
		
 Yes  No
		
		
Have you EVER persecuted (either directly or indirectly) any person because of race, religion, national origin, membership in a particular social group, or political opinion?
		
 Yes  No

		
		
Between March 23, 1933, and May 8, 1945, did you work for or associate in any way (either directly or indirectly) with: 
		

		

		The Nazi government of Germany? 
		
 Yes  No
		
Any government in any area (1) occupied by, (2) allied with, or (3) established with the help of the Nazi government of Germany? 
		
 Yes  No
		
Any German, Nazi, or S.S. military unit, paramilitary unit, self-defense unit, vigilante unit, citizen unit, police unit, government agency or office, extermination camp, concentration camp, prisoner of war camp, prison, labor camp, or transit camp? 
		
 Yes  No
		
		
		
	
		
		
	
	
	
Continuous Residence

	Since becoming a Lawful Permanent Resident of the United States:
	

	
Have you EVER called yourself a ''nonresident'' on a Federal, state, or local tax return?
	
 Yes  No
	
Have you EVER failed to file a Federal, state, or local tax return because you considered yourself to be a "nonresident"?
	
 Yes  No
	
	
	
Good Moral Character

	For the purposes of this application, 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. 

	

	
Have you EVER committed a crime or offense for which you were NOT arrested?  
	
 Yes  No
	
Have you EVER been arrested, cited, or detained by any law enforcement officer (including INS and military officers) for any reason? 
	
 Yes  No
	
Have you EVERbeen charged with committing any crime or offense? 
	
 Yes  No
 
	
Have you EVERbeen convicted of a crime or offense? 
	
 Yes  No
	
Have you EVER been placed in an alternative sentencing or a rehabilitative program (for example: diversion, deferred prosecution, withheld adjudication, deferred adjudication)?  
	
 Yes  No
	
Have you EVER received a suspended sentence, been placed on probation, or been paroled?  
	
 Yes  No
	
Have you EVER been in jail or prison? 
	
 Yes  No

	
	

		If you answered "Yes" to any of questions 15 through 21, complete the following:

		  Why were you arrested, cited, detained, or charged?
  
		  Date arrested, cited, detained, or charged (month/day/year)

		  Where were you arrested cited, detained or charged (city /state/country)

		  Outcome or disposition detention or charge. 

		
 
		

Answer questions 22 through 33. If you answer "Yes" to any of these questions, attach (1) your written explanation why your answer was ''Yes,'' and (2) any additional information or documentation that helps explain your answer. 
	
	

	Have you EVER: 
	

			
been a habitual drunkard?
			
 Yes  No 
			
been a prostitute, or procured anyone for prostitution? 
			
 Yes  No
			
sold or smuggled controlled substances, illegal drugs or narcotics? 
			
 Yes  No
			
been married to more than one person at the same time? 
			
 Yes  No
			
helped anyone enter or try to enter the United States illegally? 
			
 Yes  No
			
gambled illegally or received income from illegal gambling? 
			
 Yes  No
			
failed to support your dependents or to pay alimony? 
			
 Yes  No
	
	
Have you EVER given false or misleading information to any U.S. government official while applying for any immigration benefit or to prevent deportation, exclusion, or removal? 
	
 Yes  No
	
	
Have you EVER lied to any U.S. government official to gain entry or admission into the United States?
	
 Yes  No

	
	
	
Removal, Exclusion, and Deportation Proceedings 
		

		
Are removal, exclusion, rescission or deportation proceedings pending 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 U.S.? 
		
 Yes  No
		
Have you EVER applied for any kind of relief from removal, exclusion, or deportation? 
		
 Yes  No
		
	
	
Military Service 
	

		
Have you EVER served in the U.S. Armed Forces? 
		
 Yes  No 
		
Have you EVER left the United States to avoid being drafted into the U.S. Armed Forces? 
		
 Yes  No 
		
Have you EVER applied for any kind of exemption from military service in the U.S. Armed Forces? 
		
 Yes  No 
		
Have you EVER deserted from the U.S. Armed Forces? 
		
 Yes  No
		
	
	
Selective Service Registration 
	

	Are you a male who lived in the United States at any time between your 18th and 26th birthdays in any status except as a lawful nonimmigrant? 
			
 Yes  No 

		- If you answered "NO", go on to question 34.

		- If you answered "YES", provide the information below.

		- If you answered "YES", but you did NOT register with the Selective Service System and are still under 26 years of age, you must register before you apply for naturalization, so that you can complete the information below:

	    Date Registered (month/day/year) 
	
    Selective Service Number 

	If you answered "YES", but you did NOT register with the Selective Service and you are now 26 years old or older, attach a statement explaining why you did not register.
	

	
	
Oath Requirements

	Answer questions 34 through 39. If you answer ''No'' to any of these questions, attach (1) your written explanation why the answer was ''No'' and (2) any additional information or documentation that helps to explain your answer. 
	

		
Do you support the Constitution and form of government of the United States? 
		
 Yes  No 
		
Do you understand the full Oath of Allegiance to the United States? 
		
 Yes  No
		
Are you willing to take the full Oath of Allegiance to the United States? 
		
 Yes  No
		
If the law requires it, are you willing to bear arms on behalf of the United States? 
		
 Yes  No
		
If the law requires it, are you willing to perform noncombatant services in the U.S. Armed Forces? 
		
 Yes  No
		
If the law requires it, are you willing to perform work of national importance under civilian direction? 
		
 Yes  No
	
	
	
 







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