N-400 Questionnaire

N-400 QUESTIONNAIRE

Please answer all questions completely and truthfully. If a required field is not applicable, please write N/A or NA. The information collected will be used to prepare the naturalization application, will be kept entirely confidential and will not be disclosed to anyone without the client’s consent.

PART I. PERSONAL INFORMATION

1. Complete Name (LAST, First, Middle): *

2. Name as it exactly appears on your Permanent Resident Card, if applicable: *

3. Other Names Used, if applicable: *

4. Naturalization allows the applicant to legally change his/her name. If you like to legally change your name, print the new name you would like to use (LAST, First, Middle): *

6. Daytime Phone Number: *

7. Mobile Phone Number: *

8. Email: *

9. Date of Birth (mm/dd/yyyy): *

10. City of Birth: *

11. Country of Birth: *

12. Country of Citizenship: *

13. A-Number: *

14. U.S. Social Security Number, if any: (If you prefer to not send this sensitive information over this questionnaire, please indicate so on the box below and an alternative arrangement will be made to collect such data.) *

15. Date you became a permanent resident (mm/dd/yyyy): *

16. Port-of-entry or USCIS office where status was adjusted to permanent resident: *

18. Sex: *

Male Female

19. Height: *

20. Weight: *

21. Are you Hispanic or Latino? *

Yes No

25. Are you requesting an accommodation to the naturalization process because of a disability and/or an impairment? *

Yes No

25(a). If yes, describe the disability or impairment: *

26. Are you a permanent resident child of a U.S. citizen parent(s)? *

Yes No/Not Applicable

26(a). If yes, complete the following, otherwise, skip to Part II:

25(a)(i). Complete Name of one U.S. Citizen Parent (LAST, First, Middle): *

26(a)(ii). Complete Address of the U.S. Citizen Parent: *

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City

State

Zip Code

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26(a)(iii). The U.S. Citizen parent is the applicant's: *

Natural parent Adoptive parent Parent of child legitimized after birth

26(a)(iv). U.S. Citizen parent's citizenship was acquired: *

By birth in the United States Through naturalization

26(a)(v). If parent is a a naturalized U.S. Citizen, provide the Certificate of Naturalization Number: *

26(a)(vi). Does the U.S. Citizen parent have legal custody of you? *

Yes No

PART II. CURRENT SPOUSAL INFORMATION, IF APPLICABLE

1. Complete Name of Spouse (LAST, First, Middle): *

2. Other Names Used, if applicable: *

3. Present Address: *

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City

State

Zip Code

Country

4. Daytime Phone Number: *

5. Mobile Phone Number: *

6. Email: *

7. Date of Birth (mm/dd/yyyy): *

8. City of Birth: *

9. Country of Birth: *

10. Country of Citizenship: *

11. Date of Marriage (mm/dd/yyyy): *

12. Place of Marriage: *

13. Current Spouse's Immigration Status: *

U.S. Citizen by birth U.S. Citizen through naturalization Lawful Permanent Resident Other

13(a). If Current Spouse is a naturalized U.S. Citizen, provide the date (mm/dd/yyyy) of naturalization: *

13(b). If Current Spouse is a Lawful Permanent Resident, provide his/her A-Number: *

13(b)(i). If Current Spouse is a Lawful Permanent Resident, provide his/her country of citizenship *

13(c). If Current Spouse's immigration status is "Other," please specify: *

15. U.S. Social Security Number, if any: *

16. Current Spouse's Present Employer: *

PART III. PREVIOUS MARRIAGE INFORMATION

If you or your current spouse were previously married, please provide the following information for all prior marriages:

1. Information About Your Prior Spouse:

1(a). Complete Name of Prior Spouse (LAST, FIrst, Middle): *

1(b). Date of Marriage to Prior Spouse (mm/dd/yyyy): *

1(c). Place of Marriage to Prior Spouse: *

1(d). Date of Termination of Marriage (mm/dd/yyyy): *

1(e). How did prior marriage end? *

2. Information About Current Spouse's Former Spouse:

2(a). Complete Name of Prior Spouse (LAST, FIrst, Middle): *

2(b). Date of Marriage to Prior Spouse (mm/dd/yyyy): *

2(c). Place of Marriage to Prior Spouse: *

2(d). Date of Termination of Marriage (mm/dd/yyyy): *

2(e). How did prior marriage end? *

PART IV. MISCELLANEOUS INFORMATION

1. List all addresses where you lived during the last 5 years or since becoming a permanent resident, whichever is less.

1(a). Applicant's Present Address: *

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City

State

Zip Code

Country

1(a)(i). Date (mm/yyyy) the Applicant started residing at the above address: *

1(b). Previous Address 1: *

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City

State

Zip Code

Country

1(b)(i). Date the Applicant's residence started and ended at the above address: *

1(c). Previous Address 2: *

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City

State

Zip Code

Country

1(c)(i). Date Applicant's residence started and ended at the above address: *

1(d). Previous Address 3: *

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City

State

Zip Code

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1(d)(i). Date Applicant's residence started and ended at the above address: *

2. Information about Applicant's Employment and Schools Attended during the last 5 years.

2(a). Information on Your Current/Most Recent Employment/School:

2(a)(i). Name of Employer/School: *

2(a)(ii). Address of Employer/School: *

2(a)(iii). Occupation/Titile: *

2(a)(iv). Period of Employment/School: *

2(b). Information on Your Prior or Second Employment/School:

2(b)(i). Name of Employer/School: *

2(b)(ii). Address of Employer/School: *

2(b)(iii). Occupation/Title: *

2(b)(iv). Period of Employment/School: *

2(c). Information on Your Prior Employment/School:

2(c)(i). Name of Employer/School: *

2(c)(ii). Address of Employer/School: *

2(c)(iii). Occupation/Title: *

2(c)(iv). Period of Employment/School: *

3. Applicant's absences from the U.S. since becoming a permanent resident. If none, write "none."

3(a). Most recent trip abroad.

3(a)(i). Date of Departure from the U.S. (mm/dd/yyyy): *

3(a)(ii). Date of Return to the U.S. (mm/dd/yyyy): *

3(a)(iii). Countries Visited: *

3(a)(iv). Reason for Trip: *

3(b). Second most recent trip abroad.

3(b)(i). Date of Departure from the U.S. (mm/dd/yyyy): *

3(b)(ii). Date of Return to the U.S. (mm/dd/yyyy): *

3(b)(iii). Countries Visited: *

3(b)(iv). Reason for Trip: *

3(c). Third most recent trip abroad. *

3(c)(i). Date of Departure from the U.S. (mm/dd/yyyy): *

3(c)(ii). Date of Return to the U.S. (mm/dd/yyyy): *

3(c)(iii). Countries Visited: *

3(c)(iv). Reason for Trip: *

4. Children of the Applicant, if any:

4(a). Child 1:

4(a)(i). Complete Name of First Child (LAST, First, Middle): *

4(a)(ii). Date of Birth (mm/dd/yyyy): *

4(a)(iii). Country of Birth: *

4(a)(iv). Citizenship: *

4(a)(v). A-Number, if any: *

4(a)(vi). Is child living with the Applicant? *

Yes No

4(a)(vii). If child is not living with the Applicant, provide child's present address: *

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City

State

Zip Code

Country

4(b). Child 2:

4(b)(i). Complete Name of Second Child (LAST, First, Middle): *

4(b)(ii). Date of Birth (mm/dd/yyyy): *

4(b)(iii). Country of Birth: *

4(b)(iv). Citizenship: *

4(b)(v). A-Number, if any: *

4(b)(vi). Is child living with the Applicant? *

Yes No

4(b)(vii). If child is not living with the Applicant, provide child's present address: *

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City

State

Zip Code

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4(c). Child 3:

4(c)(i). Complete Name of Third Child (LAST, First, Middle): *

4(c)(ii). Date of Birth (mm/dd/yyyy): *

4(c)(iii). Country of Birth: *

4(c)(iv). Citizenship: *

4(c)(v). A-Number, if any: *

4(c)(vi). Is child living with the Applicant? *

Yes No

4(c)(vii). If child is not living with the Applicant, provide child's present address: *

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City

State

Zip Code

Country

4(d). Child 4:

4(d)(i). Complete Name of Fourth Child (LAST, First, Middle): *

4(d)(ii). Date of Birth (mm/dd/yyyy): *

4(d)(iii). Country of Birth: *

4(d)(iv). Citizenship: *

4(d)(v). A-Number, if any: *

4(d)(vi). Is child living with the Applicant? *

Yes No

4(d)(vii). If child is not living with the Applicant, provide child's present address: *

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City

State

Zip Code

Country

PART V. MEMBERSHIPS & ORGANIZATIONS

1. Are you currently a member of any organization, club, or group (including military service)? *

Yes No

2. Information on Organizations, if applicable:

2(a). Organization 1:

2(a)(i). Name of Organization: *

2(a)(ii). Period of Membership: *

2(b). Organization 2:

2(b)(i). Name of Organization: *

2(b)(ii). Period of Membership: *

PART VI. ADDITIONAL INFORMATION

1. Have you ever claimed to be a U.S. citizen in any way, shape or form? *

Yes No

2. Have you ever registered to vote in any federal, state, or local election in the United States? *

Yes No

3. Have you ever voted in any federal, state, or local election in the United States? *

Yes No

4. Do you now have, or did you ever have, a hereditary title or an order of nobility in any foreign country? *

Yes No

5. Have you ever been declared legally incompetent or been confined to a mental institution? *

Yes No

6. Do you owe any overdue federal, state or local taxes? *

Yes No

7. Since becoming a Lawful Permanent Resident, have you ever not filed a federal, state or local tax return? *

Yes No

8. Since becoming a Lawful Permanent Resident, have you either failed to file a tax return because you considered yourself a "non-U.S. resident?" *

Yes No Not Applicable

9. Have you been a member of, or in any way associated directly or indirectly with the Communist Party, any other totalitarian party or terrorist organization? *

Yes No

10. Have you been involved, directly or indirectly, in the overthrow of any government by force or violence? *

Yes No

11. Have you been involved, directly or indirectly, in the persecution of any person by reason of race, religion, national origin, membership in a particular social group or political opinion? *

Yes No

12. Were you ever involved in any way with any of the following: genocide; torture; killing, or trying to kill, someone; badly hurting, or trying to hurt, a person on purpose; forcing, or trying to force, someone to have any kind of sexual contact or relations; not letting someone practice his/her religion? *

Yes No

13. Did you ever provide weapons to any person, or help another person sell, give, or provide weapons to any person? *

Yes No

14. Did you ever receive any type of military, paramilitary or weapons training? *

Yes No

15. If you answer "Yes" to any of the questions in Nos. 1-14, please use the box below to explain in detail your answer. *

16. Are you a male who lived in the United States at any time between your 18th and 26th birthdays? *

Yes No Not Applicable

16(a). If "Yes," did you register for the Selective Service? *

Yes No

16(a)(i). If you registered, when did you register for the Selective Service (mm/dd/yyyy)? *

16(a)(ii). If you registered, provide your Selective Service Number: *

18. Check all that apply: *

I support the Constitution and form of government of the United States. I understand the full Oath of Allegiance to the United States. I am willing to take the full Oath of Allegiance to the United States. If the law requires it, I am willing to perform noncombatant services in the U.S. Armed Forces. If the law requires it, I am willing to perform work of national importance under civilian direction.

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N-400 QUESTIONNAIRE