INFORMATION REGARDING THE APPLICANT (i.e. the person seeking the immigration benefit): Name * First Name Last Name Email * Sex * Male Female Date of Birth MM DD YYYY Phone Number * (###) ### #### Current Address Address 1 Address 2 City State/Province Zip/Postal Code Country Country of Birth Citizenship(s) Have you ever been arrested inside or outside the United States? If so, please explain when, where, and what the outcome was. VISA INFORMATION Are you currently in the United States? * If yes, please answer the following questions. If no, please skip to the next section. Yes No If you are currently in the U.S., what is your immigration status? What visa category did you enter the U.S. with (i.e. Visa Waiver, B-1/B-2, F-1, H-1B, L-1, O-1, Lawful Permanent Resident, Entered Without Documentation, etc.) If you are currently in the U.S., what was the date of your most recent arrival? MM DD YYYY If you are currently in the U.S., what is the date your I-94 status expires? Please visit http://i94.cbp.dhs.gov to obtain your I-94 information. MM DD YYYY Please describe any questions you may have received by Customs and Border Protection upon your entry into the United States. Please provide, to the best of your knowledge, all other times you have entered the U.S. From (month/day/year) - To (month/day/year) Are you currently facing any immigration deadlines (i.e. need to respond to an RFE or denial; your visa/I-94 status is expiring; court dates; aging out for benefits; etc.)? If so, please explain and include any deadline dates. Is there any additional information you would like to provide on your situation? INFORMATION REGARDING THE U.S. SPONSOR (i.e. the U.S. citizen or lawful permanent resident family member that will sponsor the Applicant): Name * First Name Last Name Relationship to the Applicant (i.e. Boyfriend, Girlfriend, Fiancé, Spouse, Mother, Father, Sister, Brother, Child) Status * U.S. Citizen U.S. Lawful Permanent Resident Nonimmigrant Email * Sex * Male Female Date of Birth MM DD YYYY Phone Number (###) ### #### Current Address Address 1 Address 2 City State/Province Zip/Postal Code Country Country of Birth Citizenship Name of current employer Present Occupation Thank you!
