Before you begin this questionnaire
PART 1. Your Name (person applying for naturalization)
A. Your current legal name
*
First Name
Middle Name
Last Name
B. Your name exactly as it appears on your Permanent Resident Card
*
First Name
Middle Name
Last Name
C. If you have ever used other names, provide them below:
First Name
Middle Name
Last Name
PART 2. Information about Your Eligibility.
Were one or both of your parents U.S. Citizens when you were born?
*
Yes
No
Unsure
I am at least 18 years old and: (Please note that if none of these options apply to you, you may not be ready to apply for Naturalization.)
*
I have been a lawful permanent resident of the United States for at least five years.
I have been a lawful permanent resident of the United States for at least three years, and I have been married to and living with the same U.S. citizen for the last three years, and my spouse has been a U.S. citizen for the last three years.
I am applying on the basis of qualifying military service.
Other
Part 3. Information About You
A. Date of Birth
*
-
Month
-
Day
Year
Date
B. Date You Became a Permanent Resident
*
-
Month
-
Day
Year
Date
C. City, State & Country of Birth
D. What is your current marital status?
Single, Never Married
Married
Divorced
Widowed
Marriage Annulled
Other
PART 4. Addresses and Contact Information
A. Home Address (Do NOT write a P.O. Box in this space.)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
B. Care of Mailing Address (if different from home address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
C. Daytime Phone Number
*
Please enter a valid phone number.
D. Evening Phone Number
Please enter a valid phone number.
E. Email Address
example@example.com
PART 5. Information about Your Residence and Employment
A. Where have you lived during the last five years? Begin with where you live now and then list every place you have lived prior to that for the last five years.
Address, City, State, Zip Code, and County
Date From
Date To
Address 1
Address 2
Address 3
Address 4
Present Address
B. Where have you worked (or, if you were a student, what schools did you attend) during the last five years? Include military service. Begin with your current or latest employer and then list every place you have worked or studied.
Employer/School Name
Employer or School Address
Date From
Date To
Your Occupation
1
2
3
4
5
6
7
8
9
10
PART 6. Time Outside the United States (including trips to Canada, Mexico, and the Caribbean)
A. How many trips of 24 hours or more have you taken outside of the United States during the past five years?
B. List below all the trips of 24 hours or more that you have taken outside of the United States during the las 5 years. Begin with your most recent trip.
Date you left the U.S.
Date you returned to the U.S.
Did Trip Last 6 months or more?
Countries Travelled
Total Days out of the US
1
2
3
4
5
6
7
8
9
10
PART 7. Information about Your Current Spouse (Skip to part 8 if this does not apply to you.)
IMPORTANT NOTE: If you or your spouse were previously married you will need to bring all divorce records.
A. Your Spouse's name
First Name
Last Name
B. Your Spouse's Date of Birth.
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Month
-
Day
Year
Date
C. When did you marry your spouse?
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Month
-
Day
Year
Date
D. If you spouse naturalized, when did they naturalize?
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Month
-
Day
Year
Date
If your spouse is not a U.S. Citizen, please provide the following information:
PART 8. Information about Your Children (Skip to part 9 if this does not apply to you.)
List below your children's information (this includes biological, step, adopted, married, deceased etc.)
Full Name
Date of Birth
A-Number (If any)
Country of Birth
Current Address
Child 1
Child
2
Child
3
Child
4
Child
5
Child
6
Child
7
Child
8
Child
9
Child
10
PART 9. Additional Questions
A. Are you a male who lived in the United States between your 18th and 26th birthday?
*
Yes
No
If you answered "Yes," did you register for the Selective Services?
Yes
No
If you registered for the Selective Services, please provide the following:
If you did NOT register and you are: (A)Still under 26 Years old, you must register before you apply for naturalization OR (B) Now 26-31 years old, please explain below why you did not register.
B. Have you EVER committed, assisted in committing, or attempted to commit, a crime or offense for which you were NOT arrested?
*
Yes
No
C. Have you EVER been charged with committing, attempting to commit, or assisting in committing a crime or offense?
*
Yes
No
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