Enter your A-Number if one has been assigned. Use the number shown on your immigration or removal records.

Enter your Family Name, Given Name and Middle Name exactly according to your current legal identity records.

List all other names you have ever used, including aliases, maiden names, former legal names and nicknames.

If you are outside the United States, provide a U.S. mailing address if available. If none is available, provide your foreign mailing address.

Enter your U.S. Social Security Number if one has been issued.

Enter your USCIS Online Account Number if one has been assigned.

Provide your date of birth, city or town of birth, state or province if applicable and country of birth.

Provide your current country of citizenship or nationality.

Provide the DOS consular case number if available.

Provide the city or town and country of the U.S. Embassy or Consulate where the visa application is being or will be processed.

Provide the USCIS receipt number, filing location and filing date for the adjustment application.

This includes applicable expedited removal under INA 235(b)(1) or removal at the end of INA 240 proceedings as an arriving alien.

Select the applicable box when you were removed only once as an arriving alien and the last removal occurred less than five years ago.

Select when you have been removed two or more times and your last removal was less than 20 years ago.

Indicate if you were convicted of an aggravated felony in the United States or abroad before or after removal.

Provide the removal date, city or town and state from which you were removed.

Select Yes when you were removed under INA 240 or another applicable provision, or departed while an order of removal was outstanding.

Select the applicable box when you have only one qualifying removal and it occurred less than ten years ago.

Select when you were removed two or more times and your most recent removal occurred less than 20 years ago.

Disclose applicable aggravated-felony convictions and provide the required information in Part 9.

Provide each relevant exclusion, deportation or removal date and the location from which you were removed.

This section applies when, after accumulating more than one year of unlawful presence in the aggregate on or after April 1, 1997, you later entered or attempted to enter the United States without being admitted or paroled.

List every applicable period of unlawful presence, beginning with the most recent. Include periods when you overstayed an authorized stay where those periods count under the law.

Provide the date and location of the departure following the unlawful-presence period.

Provide the location and date of the later entry or attempted entry without admission or parole.

List every applicable date on which you were excluded, deported or removed.

Provide the city or town, state and date of the later entry or attempted entry.

Explain the genuine reason you are seeking permission to return. Connect the request to your immigration process, family ties, employment, education, or other actual circumstances.

Provide the Family Name, Given Name and Middle Name of each relevant U.S. citizen or lawful permanent resident family member.

State the actual relationship, such as spouse, parent, son, daughter or another family relationship.

Select every race category that applies.

Enter height in feet and inches and weight in pounds.

Select the applicable eye-color and hair-color options.

Begin with your current residence. Provide the full physical address and the dates you lived there.

List every place you physically lived during the previous ten years, inside or outside the United States.

List your current or most recent employer first, then continue backward for the required five-year period.

Provide the employer's complete address, including city, state or province, postal code and country.

State your occupation and the beginning and ending dates of the employment. Mark the current job appropriately where applicable.

If currently married, provide the current spouse's complete legal name.

Provide the spouse's A-Number if one has been assigned.

Provide the spouse's date of birth and your legal marriage date.

Provide city or town, state or province where applicable, and country of birth.

Provide the city or town, state or province and country where the current marriage took place.

If previously married, provide the prior spouse's legal name, including the family name before marriage where requested.

Provide the prior spouse's date of birth.

Provide the date and location where the prior marriage took place.

Provide the legal termination date and location for divorce, annulment or another applicable termination.

Provide your current daytime telephone number.

Provide your mobile telephone number if applicable.

Provide your current email address if applicable.

By signing, you certify under penalty of perjury that the responses and information submitted are complete, true and correct.

Provide the interpreter's Family Name and Given Name.

Provide the interpreter's business or organization name where applicable.

Provide the interpreter's daytime telephone, mobile number and email address where applicable.

The interpreter certifies fluency in English and the language used to interpret the application, then signs and dates the section.

Provide the preparer's Family Name and Given Name.

Provide the preparer's business or organization name where applicable.

Provide daytime telephone, mobile telephone and email information where applicable.

The preparer certifies that the application was prepared at the applicant's request using information supplied or authorized by the applicant, then signs and dates the section.

Provide your identifying information at the top of each additional-information page.

Identify exactly which question each continuation or explanation relates to.

If additional pages are necessary, place your name and A-Number at the top, identify the related page, part and item, and sign and date each additional sheet as required.

Provide relevant removal orders, expedited removal records, immigration-court decisions, departure records and other documentation establishing your immigration history.

Where relevant, provide passport records, I-94 records, travel history, border records and evidence showing dates outside the United States.

Provide reliable records demonstrating the applicable continuous period outside the United States after the relevant departure.

Provide official police records and court records required by the instructions. The current instructions state that official police records from relevant countries generally must be recent enough to satisfy the filing requirements.

Provide birth certificates, marriage certificates, proof of U.S. citizenship or lawful permanent residence, and other documents establishing relevant family relationships.

Where applicable, provide evidence of rehabilitation, law-abiding conduct, treatment, community involvement and responsible conduct since the adverse immigration or criminal history.

Where hardship is a favorable discretionary factor, provide reliable medical, financial, family and other evidence showing the actual consequences of continued inadmissibility.

USCIS or CBP weighs favorable and unfavorable circumstances. Provide evidence supporting genuine positive factors such as family ties, rehabilitation, length of lawful residence, employment, community ties and other circumstances relevant to your case.

If your name changed, include applicable marriage certificates, divorce decrees, adoption decrees, naturalization records or court orders.

Every foreign-language document submitted must include a complete English translation and the required translator certification.