Green Card Applicant Information Sheet

GREEN CARD APPLICANT INFORMATION SHEET

Applicant Information

Last Name
Maiden Name
Middle Name
First Name
Other Names
Date of Birth
City of Birth
Province of Birth
Country of Birth
Citizenship
U.S. Social Security #
A # (if applicable)

Applicant’s Immigration information

Current Visa Status
I-94 Number
I-94 Date of Expiration
Give your name as it appears on the I94 card
Date of Last Entry to the U.S.
Place of Last Entry to the U.S.
Type of Visa Issued on Last Entry
Date of Visa Issuance
Place of Visa Issuance (Consulate)
Nonimmigrant Visa Number
Passport Number
Have you ever held F visa status? If yes, provide exact dates status was held.
Have you ever held J visa status? If yes, provide exact dates status was held.
If yes, are you subject to the home residence requirement?
If yes, have you obtained a waiver of that requirement?

APPLICANT’S Mother’s Information

Last Name / City of Birth
Maiden Name / Country of Birth
First Name / City of Residence
Date of Birth (mm/dd/yyyy) / Country of Residence

APPLICANT’s father’s Information

Last Name / City of Birth
First Name / Country of Birth
Date of Birth (mm/dd/yyyy) / City of Residence
Country of Residence

Applicant’s Address for the past 5 years

1. Street Address / 3. Street Address
Apt/Fl # / Apt/Fl #
City / City
State / State
Zip / Zip
From (mm/yyyy) / From (mm/yyyy)
To (mm/yyyy) / To (mm/yyyy)
2. Street Address / 4. Street Address
Apt/Fl # / Apt/Fl #
City / City
State / State
Zip / Zip
From (mm/yyyy) / From (mm/yyyy)
To (mm/yyyy) / To (mm/yyyy)

Applicant’s Last address outside the u.s. for more than one year

Street / From (mm/yyyy)
Apt/Fl # / To (mm/yyyy)
City / Province
Country / Postal Code

Applicant’s Employment History in the u.s. in the past 5 years

1. Name of Employer
Address of Employer
Job Title
From (mm/yyyy)
To (mm/yyyy)
2. Name of Employer
Address of Employer
Job Title
From (mm/yyyy)
To (mm/yyyy)
3. Name of Employer
Address of Employer
Job Title
From (mm/yyyy)
To (mm/yyyy)

Applicant’s last occupation outside the u.s.

Name of Employer
Address of Employer
Job Title
From (mm/yyyy)
To (mm/yyyy)

Applicant’s Membership in organizations

1. Name of Organization / Location
Membership Date From (mm/yyyy) / Membership Date To (mm/yyyy)
2. Name of Organization / Location
Membership Date From (mm/yyyy) / Membership Date To (mm/yyyy)
3. Name of Organization / Location
Membership Date From (mm/yyyy) / Membership Date To (mm/yyyy)

Spouse Information

Last Name / City of Birth
Maiden Name / Country of Birth
Middle Name / Place of Marriage (city and country)
First Name / Date of Marriage (mm/dd/yyyy)
Date of Birth (mm/dd/yyyy) / U.S. Social Security #
Name & Date of Birth of Prior Spouse / Date & Place of Prior Marriage / Date & Place of Termination

Child Immigration information - 1

Last name / Date of Last Entry to the U.S.
First Name / Place of Last Entry to the U.S.
Middle Name / Type of Visa Issued on Last Entry
Date of Birth (mm/dd/yyyy) / U.S. Social Security #
City of Birth / Passport Number
Country of Birth / Nonimmigrant Visa Number
Current Visa Status / Date of Visa Issuance
I-94 Number / Place of Visa Issuance (Consulate)
I-94 Date of Expiration / Applying for U.S. permanent residence? Yes or No
Last Address Outside U.S.

Child Immigration information -2

(Please include information for additional children)

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