Part 1. Information About Person or Organization Filing This Petition (continued)
7.
Alternate and/or Safe Mailing Address
If you are a VAWA self-petitioning spouse, child, parent, or a special immigrant juvenile and do not want U.S. Citizenship and
Immigration Services (USCIS) to send notices about this petition to your home, you may provide an alternate and/or safe mailing
address.
In Care Of Name (if any)
Street Number and Name
Apt.
Ste.
Flr. Number
City or Town
State
ZIP Code
Province
Postal Code
Country
Part 2. Classification Requested
Select only one box.
1.
A.
Amerasian
B.
Widow(er) of a U.S. citizen
C.
Special Immigrant Juvenile
D.
Special Immigrant Religious Worker
(1)
Will the beneficiary be working as a minister?
Yes
No
E.
Special Immigrant based on employment with the Panama Canal Company, Canal Zone Government, or U.S.
Government in the Canal Zone
F.
Special Immigrant Physician
G.
Special Immigrant G-4 International Organization Employee or Family Member or NATO-6 Employee or Family
Member
H.
Special Immigrant Armed Forces Member
I.
Self-Petitioning Spouse of Abusive U.S. citizen or Lawful Permanent Resident
J.
Self-Petitioning Child of Abusive U.S. citizen or Lawful Permanent Resident
K.
VAWA Self-Petitioning Parent of a U.S. citizen son or daughter
L.
Special Immigrant Afghanistan or Iraq National who worked with the U.S. Armed Forces as a translator
M.
Special Immigrant Iraq National who was employed by or on behalf of the U.S. Government
N.
Special Immigrant Afghanistan National who was employed by or on behalf of the U.S. Government or the
International Security Assistance Force (ISAF) in Afghanistan
O.
Broadcasters
P.
Other
Provide the name of the classification below.
Form I-360 12/23/16 N
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