Name * First Last Phone * Email * ADDRESS * BEST Time TO CONTACT Morning Afternoon Anytime SECTION 1 WERE YOU BORN AFTER JUNE 15, 1981?IF YES, WHAT DATE? * DID YOU COME TO THE UNITED STATES BEFORE YOUR 16TH BIRTHDAY? YES NO HAVE YOU CONTINUOUSLY RESIDED IN TH UNITED STATES SINCE JUNE 15, 2012? YES NO WERE YOU PHYSICALLY PRESENT IN TH UNITED STATES ON JUNE 15, 2012? YES NO ARE YOU CURRENTLY PHYSICALLY PRESENT IN THE UNITED STATES? YES NO DID YOU ENTER THE UNITED STATES WITHOUT INSPECTION BEFORE JUNE 15, 2012 OR LOSE YOUR LAWFUL STATUS AS OF JUNE 15, 2012? YES NO ARE YOU CURRENTLY IN SCHOOL, HAVE GRADUATED OR OBTAINED A CERTIFICATE OF COMPLETION FROM HIGH SCHOOL, HAVE OBTAINED A GED CERTIFICATE, OR ARE AN HONORABLY DISCHARGED VETERAN OF THE COAST GUARD OF ARMED FORCES OF THE UNITED STATS? YES NO HAVE YOU BEEN CONVICTED OF A FELONY OR MISDEMEANOR? YES NO SECTION 2 WHEN WAS THE FIRST TIME YOU ENTERED THE UNITED STATES? WHEN WAS THE MOST RECENT TIME THAT YOU ENTERED THE UNITE STATES? are you married? Yes No if yes, is your spouse a U.S.Citizen Lawful Permanent Resident None of The Above do you have any children or step-children? Yes No if yes, please list children: name, date of birth, and place of birth are either of your parents a U.S. Citizen or lawful permanent resident?<br>MOTHER U.S.Citizen Lawful Permanent Resident None of The Above FATHER U.S.Citizen Lawful Permanent Resident None of The Above ARE ANY OF YOUR SIBLINGS U.S. CITIZENS OR LAWFUL PERMANENT RESIDENTS?<br>SISTER U.S.Citizen Lawful Permanent Resident None of The Above BROTHER U.S.Citizen Lawful Permanent Resident None of The Above HAS ANY IMMIGRATION PETITION EVER BEEN FILED FOR YOU OR YOUR PARENTS? Yes No HAVE YOU EVER BEEN DEPORTED FROM THE U.S.? Yes No COMMENTS submit Form
