Form I-360 - Petition For Amerasian, Widow(Er), Or Special Immigrant Page 4

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Part 4. Processing Information (continued)
2.
If a U.S. address was provided in Part 3., type or print the person's foreign address below. If he or she does not maintain a
foreign address, list the city or town and country of last foreign residence. If his or her native alphabet does not use Roman
letters, type or print his or her name and foreign address in the native alphabet.
A.
Your Full Name
Family Name (Last Name)
Given Name (First Name)
Middle Name
B. Mailing Address
Street Number and Name
Apt.
Ste.
Flr. Number
City or Town
Province
Postal Code
Country
3.
Gender of the beneficiary:
Male
Female
4.
A.
Are you filing any other petitions or applications with this one?
Yes
No
B.
If you answered "Yes" to Item A. in Item Number 4., how many?
If you answer "Yes" to Item Numbers 5. - 6., provide an explanation in the space provided in Part 15. Additional Information.
5.
Is the beneficiary in removal proceedings?
Yes
No
6.
Has the beneficiary ever worked in the U.S. without permission? (If you are applying for a special
Yes
No
immigrant juvenile status, you are not required to answer this item number.)
7.
Is an application for adjustment of status attached to this petition?
Yes
No
Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being Filed
NOTE: Depending on the classification you seek, you can either file this petition for another person or for yourself. On this petition,
the "beneficiary" or "self-petitioner" means the person for whom this petition is being filed, whether that person is yourself or another
person.
1.
If you are filing as a self-petitioning spouse, have any of your children filed separate self-petitions?
Yes
No
2.
Person 1
Family Name (Last Name)
Given Name (First Name)
Middle Name
Date of Birth (mm/dd/yyyy)
Country of Birth
Relationship
A-Number (if any)
Spouse
Child
A-
Form I-360 12/23/16 N
Page 4 of 19

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