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1345 Avenue of the Americas, 2nd Floor
New York, NY 10105
ken
garcia
attorney at law
_________________________________
Immigration & Nationality Law
FREE CONSULTATION
NATURALIZATION ELIGIBILITY 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 evaluate your eligibility to apply for naturalization, 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. Present Address:
*
Line 1
Line 2
City
State
Zip Code
Country
3. Mobile Phone Number:
*
4. Email:
*
5. Date of Birth (mm/dd/yyyy):
*
6. City of Birth:
*
7. Country of Birth:
*
8. Country of Citizenship:
*
9. Sex:
*
Male
Female
10. Civil Status:
*
Single
Married
Separated
DIvorced
Widowed
Marriage Annulled
11. Date you became a permanent resident (mm/dd/yyyy):
*
Write "N/A" if not applicable.
12. Did you acquire your Lawful Permanent Resident status based on marriage to a U.S. Citizen?
*
Yes
No
13. Are you requesting an accommodation to the naturalization process because of a disability and/or an impairment?
*
Yes
No
13(a). If yes, describe the disability or impairment:
*
14. Are you an active-duty member of the U.S. Armed Forces?
*
Yes
No
15. Have you been a Lawful Permanent Resident for at least 5 years (3 years if you acquired permanent resident status by way of marriage petition filed by your U.S. Citizen spouse)?
*
Yes
No
16. During the last 5 years (3 years if you acquired permanent resident status by way of a marriage petition filed by your U.S. Citizen spouse), have you taken a trip outside the U.S. that lasted for more than 6 months?
*
Yes
No
17. During the last 5 years (3 years if you acquired permanent resident status by way of a marriage petition filed by your U.S. Citizen spouse), list all the trips taken abroad and indicate all dates (of approximate dates will also suffice) of departure from and return to the US.
*
18. Are you a male who lived in the United States at any time between your 18th and 26th birthdays?
*
Yes
No
Not Applicable
18(a). If "Yes," did you register for the Selective Service?
*
Yes
No
19. Check all that apply:
*
I have committed, assisted in committing, or attempted to commit, a crime or offense for which I was not arrested.
I have been arrested, cited, or detained by any law enforcement officer for any reason.
I have been charged with committing, attempting to commit, or assisting in committing a crime or offense.
I have been convicted of a crime or offense.
I have been placed in an alternative sentencing or rehabilitative program (e.g. diversion, deferred prosecution, withheld adjudication, deferred adjudication).
I have received a suspended sentence, been placed on probation, or been paroled.
I have been in jail or prison.
I have been a habitual drunkard.
I have been a prostitute, or procured anyone for prostitution.
I have sold or smuggled controlled substances, illegal drugs, or narcotics.
I have been married to more than one person at a time.
I have been married to someone in order to obtain an immigration benefit.
I have gambled illegally or received income from illegal gambling.
I have failed to support my dependents or pay alimony.
I have made a misrepresentation to obtain a public benefit in the United States.
I have given false, fraudulent or misleading information or documentation to a U.S. Government official.
I have been removed, excluded, or deported from the United States.
I have been ordered removed, excluded, or deported from the United States.
I have been placed in removal, exclusion, rescission, or deportation proceedings.
Removal, exclusion, rescission, or deportation proceedings (including administratively closed proceedings) are currently pending against me.
I have served in the U.S. Armed Forces.
I have been court-martialed, administratively separated, or disciplined, or have received an other than honorable discharge, while in the U.S. Armed Forces.
I have been discharged from training or service in the U.S. Armed Forces because I was an alien.
I have left the United States to avoid being drafted in the U.S Armed Forces.
I have deserted from the U.S. Armed Forces.
None of the above is applicable.
20. 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.
21. Check all that apply:
*
I am receiving a means-tested benefit.
My household income is at or below 150% of the Federal Poverty Guidelines.
I have some financial hardship situation such as recent unemployment, high medical expenses, and/or other unexpected large expenses that I would want USCIS to consider when determining eligibility for a fee waiver.
None of the above is applicable.
Examples if means-tested benefit programs are Medicaid, Food Stamps (now known as "SNAP" benefits), TANF, SSI, among others. Compare your household income with the Federal Poverty Guidelines in effect at the time of filing. The Form I-864P Federal Poverty Guideline is available at the USCIS website, under Forms.
Submit