Form I-914 - Supplement A, Application For Family Member Of T-1 Recipient - U.s. Citizenship And Immigration Services Page 4
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9PART E. Processing Information (continued)
Yes
No
f. Received a suspended sentence, been placed on probation, or been paroled?
g. Been in jail or prison?
Yes
No
h. Been the beneficiary of a pardon, amnesty, rehabilitation, or other act of clemency or similar action?
Yes
No
i. Exercised diplomatic immunity to avoid prosecution for a criminal offense in the United States?
Yes
No
If the answer is “Yes” to any of the above questions, complete the following table. If you need more space, use a separate sheet
of paper.
Why was the family member for whom
Date of arrest,
Where was the family member
Outcome or disposition
you are filing arrested, cited, detained,
citation,
for whom you are filing arrested,
(e.g., no charges filed,
or charged?
detention, charge
cited, detained, or charged?
charges dismissed, jail,
(mm/dd/yyyy)
(City, State, Country)
probation, etc.)
2. Has the family member for whom you are filing:
a. Engaged in prostitution or procurement of prostitution or does he or she intend to engage in prostitution
Yes
No
or procurement of prostitution?
b. EVER engaged in any unlawful commercialized vice, including but not limited to illegal gambling?
Yes
No
c. EVER knowingly encouraged, induced, assisted, abetted, or aided any alien to try to enter the United
Yes
No
States illegally?
d. EVER illicitly trafficked in any controlled substance, or knowingly assisted, abetted, or colluded in the
No
Yes
illicit trafficking of any controlled substance?
3. Has the family member for whom you are filing EVER committed, planned or prepared, participated in, threatened to, attempted
to, or conspired to commit, gathered information for, or solicited funds for any of the following:
Yes
No
a. Hijacking or sabotage of any conveyance (including an aircraft, vessel, or vehicle)?
b. Seizing or detaining, and threatening to kill, injure, or continue to detain, another individual in order to
No
Yes
compel a third person (including a governmental organization) to do or abstain from doing any act as an
explicit or implicit condition for the release of the individual seized or detained?
c. Assassination?
Yes
No
d. The use of any firearm with intent to endanger, directly or indirectly, the safety of one or more individual
No
Yes
or to cause substantial damage to property?
e. The use of any biological agent; chemical agent; or nuclear weapon or device; explosive; or other weapon
No
Yes
or dangerous device, with intent to endanger, directly or indirectly, the safety of one or more individuals
or to cause substantial damage to property?
Form I-914, Supplement A 02/27/17 Y
Page 4
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