USCIS Form I-821D - Consideration of Deferred Action for Childhood Arrivals

Are you currently in immigration detention? *

Yes

No

I am requesting: *

Initial request for consideration of DACA

Renewal request for consideration of DACA

My DACA status expires on: *

Have you continuously resided in the U.S. since June 15, 2007, and up to the present time? *

Yes

No

Did you depart the United States on or after August 15, 2012, without advance parole? *

Yes

No

Have you ever served honorably in the U.S. armed forces? *

Yes

No

Have you been convicted of a felony, significant misdeanor, three or more other misdeanors, or post a threat to national security or public safety? *

Yes

No

Have you EVER been arrested for, charged with, or convicted of a felony or misdemeanor in the United States? *

Yes

No

Your answer to this question suggests that you have a history which may require the assistance of a legal professional. We want the best result for you, and therefore CitizenPath suggests that you consult with an experienced immigration attorney before continuing.

I acknowledge that I have spoken to an attorney and / or want to continue anyway *

Yes

No

Have you EVER been arrested for, charged with, or convicted of a crime in any country other than the United States? *

Yes

No

Your answer to this question suggests that you have a history which may require the assistance of a legal professional. We want the best result for you, and therefore CitizenPath suggests that you consult with an experienced immigration attorney that can provide you with additional guidance and representation.

I've acknowledge that I have spoken to an attorney and / or want to continue anyway *

Yes

No

Have you EVER engaged in or do you continue to engage in or plan to engage in terrorist activities? *

Yes

No

Are you NOW or have you EVER been a member of a gang? *

Yes

No

Your answer to this question suggests that you have a history which may require the assistance of a legal professional. We want the best result for you, and therefore CitizenPath suggests that you consult with an experienced immigration attorney before continuing.

Acknowledge that I have spoken to an attorney and / or want to continue anyway *

Yes

No

Have you EVER engaged in, ordered, incited, assisted or otherwise participated in any of the following:

Acts involving torture, genocide, or human trafficking? *

Yes

No

Killing any person? *

Yes

No

Severely injuring any person? *

Yes

No

Any kind of sexual contact or relations with any person who was being forced or threatened? *

Yes

No

Have you EVER recruited, enlisted, conscripted, or used any person to serve in or help an armed force or group while such person was under age 15? *

Yes

No

Have you EVER used any person under age 15 to take part in hostilities, or to help or provide services to people in combat? *

Yes

No

Removal Proceedings

Are you NOW or have you EVER been in removal proceedings, or do you have a removal order issued in any context (for example, at the border or within the United States by an immigration agent)? *

Yes

No

Your answer to this question suggests that you have a history which may require the assistance of a legal professional. We want the best result for you, and therefore CitizenPath suggests that you consult with an experienced immigration attorney before continuing.

I've acknowledge that I have spoken to an attorney or want to continue anyway *

Yes

What is your current status or outcome of your removal proceedings? *

Most recent date of proceedings: *

Location of proceedings: *

Location

Applicant's Full Name *

Given Name (First Name)
Middle Name
Family Name (Last Name)

Have you used any other names since birth? *

Yes

No

Other Name *

Given Name (First Name)
Middle Name(s)
Family Name (Last Name)

What is your date of birth? *

Town or City *

State or Province (if any) *

Country *

What is your country of citizenship/nationality? *

Country

What is your current country of residence? *

Country

When was your initial entry into the United States (on or approximately)? *

Place of initial entry into the United States: *

-Enter-

What was your status on June 15, 2012? *

Arrival/Departure Record

Were you ever issued an Arrival/Departure Record (I-94, I-94W, or I-95)? *

Yes

No

Enter your I-94, I-94W, or I-95 number:

Enter

I was issued an Arrival/Departure Record but have no way of finding the number.

Yes

Through what date were you authorized to stay in the U.S.? *

Most Recent Entry into the United States

When did you last enter the United States? *

Where did you last enter the United States? *

Enter the name of the city and state that you last entered the U.S. with your parents. If you do not know, "Unknown" is an acceptable answer.

What was your immigration status when you last entered the United States? *

Enter

Alien Registration Number (A-Number) *

A-

What is the USCIS #? *

USCIS#

Have you left the United States for any period since your last Form I-821D that was approved? *

Yes

No

Trip Details

Departure Date *

Return Date *

Reason for Trip *

Enter

Have you left the United States without advance parole on or after August 15, 2012? *

Yes

No

Have you ever had a passport? *

Yes

No

Passport Details

Your Passport Details *

DetailsCountry That Issued Your Last Passport
Passport Number

Passport Expiration Date *

Have you ever had a Border Crossing Card? *

Yes

No

Border Crossing Card Number *

Enter

Applicant's U.S. Mailing Address *

In Care of Name (if any)
Street Number and Name
Is there an apartment, suite or floor?
City
State
Zip Code

Is your mailing address different than your physical address? *

Yes

No

Current Physical Address *

Street Number and Name
City or Town
Country

Date you began living at the address above: *

Have you lived at any other address since you submitted your most recent Form I-821D that was approved? *

Yes

No

Your Previous Address *

Street Number and Name
Is there an apartment, suite or floor?
City or Town
State (or Territory)
ZIP Code

From: *

Contact Information *

Daytime Phone Number
Mobile Phone Number (if any)
Email Address

Has the Social Security Administration (SSA) ever officially issued a Social Security card to you? *

Yes

No

What is your Social Security Number (SSN)?

I don't know my Social Security Number?

Yes

Do you want the SSA to issue you a replacement Social Security card? *

Yes

No

Do you authorize the disclosure of information from this application to the SSA as required for the purpose of assigning you an SSN (if necessary) and issuing you a Social Security card? *

Yes

No

Economic Need to Work

Economic Need to Work *

Your current annual income is:
Your current annual expenses are
The total current value of my assets is:

If you would like to provide an explanation regarding your current financial information or your economic need for employment authorization, please use this space:

enter

Did you receive help from an interpreter to prepare this application? *

Yes

No

In which language did the interpreter communicate the questions and instructions to you? *

Enter here

What is the name of the interpreter? *

First Name
Last Name

U.S. mailing address of the interpreter? *

Street Number and Name
Apartment/Suite/Unit#
City/Town
State
Zip Code
Country

What is the daytime telephone number of the interpreter? *

Country
Area Code
Number (no hyphen)

Who prepared this application? *

I am the applicant, and I prepared this application.

I am not an attorney or accredited representative but have prepared this application on behalf of the applicant and with the applicant's consent.

I am an attorney or accredited representative of the applicant that prepared this application.

What is the name of the preparer? *

First Name
Last Name

What is the U.S. mailing address of the preparer? *

What is the U.S. mailing address of the preparer?
Apartment/Suite/Unit#
City/Town
State
Zip Code
Country

Preparer's Contact Information *

Daytime Telephone Number
Mobile Phone Number (if any)
Email Address (if any)

My representation of the applicant in this case: *

Extends beyond the preparation of this application.

Does not extend beyond the preparation of this application.

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