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- Do you want to change your name?
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- Date of Birth*
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- Date became a permanent resident*
- Was at least one parent a U.S. citizen before you turned 18?
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- Do you request a new or replacement SSA card?
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- Do you need Form N-648 (Medical Certification for Disability Exceptions)?
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- Race*
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- Current Spouse - Date of Birth
- Current Spouse - Date of Marriage
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- Do you support the Constitution and form of government of the United States?*
- Are you willing to bear arms on behalf of the United States when required by law?*
- Are you willing to take the full Oath of Allegiance to the United States?*
- Have you ever voted in any U.S. federal, state, or local election?
- Have you ever failed to file a federal, state, or local tax return when required?
- Have you ever claimed to be a U.S. citizen when you were not one?
- Have you ever belonged to, supported, or been associated with any organization, association, fund, foundation, party, club, or similar group?
- Have you ever advocated or supported the violent overthrow of any government?
- Have you ever been a member of, or affiliated with, any group involved in violence, weapons training, or armed activity?
- Have you ever committed, assisted in, or attempted to commit any crime or offense for which you were not arrested?
- Have you ever been arrested, cited, charged, convicted, or detained by any law enforcement authority?
- Have you ever failed to appear for a hearing, or violated any court order, probation, parole, or other supervised release?
- Have you ever entered or remained in the United States unlawfully?
- Have you ever helped anyone enter or remain in the United States unlawfully?
- Have you ever failed to register for Selective Service when required?
- Do you have any children, former spouses, dependents, or others for whom you provide or have provided financial support that may affect your eligibility?
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Format: (000) 000-0000.
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Format: (000) 000-0000.
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- Date of Signature*
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- Should be Empty: