Part 2. Application Type
1.a.
I am a permanent resident or conditional resident of
2.e. Country of Birth
the United States, and I am applying for a reentry
permit.
2.f.
Country of Citizenship
1.b.
I now hold U.S. refugee or asylee status, and I am
applying for a Refugee Travel Document.
1.c.
I am a permanent resident as a direct result of refugee
(
)
2.g.
Daytime Phone Number
-
or asylee status, and I am applying for a Refugee
Travel Document.
Physical Address (If you checked box 1.f.)
1.d.
I am applying for an Advance Parole Document to
allow me to return to the United States after
2.h.
In Care of Name
temporary foreign travel.
1.e.
I am outside the United States, and I am applying for
2.i.
Street Number
an Advance Parole Document.
and Name
1.f.
I am applying for an Advance Parole Document for a
2.j.
Apt.
Ste.
Flr.
person who is outside the United States.
2.k.
City or Town
If you checked box "1.f." provide the following information
about that person in 2.a. through 2.p.
2.l.
State
2.m.
ZIP Code
2.a.
Family Name
(Last Name)
2.n. Postal Code
2.b.
Given Name
(First Name)
2.o.
Province
2.c.
Middle Name
2.p.
Country
►
2.d.
Date of Birth
(mm/dd/yyyy)
Part 3. Processing Information
4.a.
Have you ever before been issued a reentry permit or
1.
Date of Intended Departure
Refugee Travel Document? (If "Yes" give the following
►
(mm/dd/yyyy)
information for the last document issued to you):
Yes
No
2.
Expected Length of Trip (in days)
►
4.b.
Date Issued
(mm/dd/yyyy)
3.a.
Are you, or any person included in this application, now
in exclusion, deportation, removal, or rescission
4.c.
Disposition (attached, lost, etc.):
proceedings?
Yes
No
3.b.
If "Yes", Name of DHS office:
If you are applying for a non-DACA related Advance Parole Document, skip to Part 7; DACA recipients must complete Part 4
before skipping to Part 7.
Form I-131 12/23/16 N
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