Form I-360 - Petition For Amerasian, Widow(Er), Or Special Immigrant Page 9
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19Part 8. Complete Only If Filing for a Special Immigrant Juvenile (continued)
3.
A.
If you answered "Yes" to Item C. in Item Number 2. above, are you currently residing in your
Yes
No
court-ordered placement?
B.
If you answered "No" to Item C. in Item Number 2. above, select your reason below.
You were adopted or placed in a permanent guardianship or another permanent living arrangement (other than
reunification with the abusive parents).
You aged-out of the juvenile court's jurisdiction and the order was terminated based on age.
Other. (If you selected "Other," provide an explanation in the space provided in Part 15. Additional Information.)
4.
A.
A juvenile court has determined that reunification with
one or
both of my parents is not viable due to:
Abuse
Neglect
Abandonment
Similar basis under state law (specify):
B.
If you selected "one" in Item A. in Item Number 4., provide the name of that parent below.
5.
Has it been determined in judicial or administrative proceedings that it would not be in your best interest
Yes
No
to be returned to your or your parent's country of citizenship or nationality or last habitual residence?
6.
A.
Are you currently or were you previously in the custody of the U.S. Department of Health and
Yes
No
Human Services (HHS)?
B.
If you answered "Yes" to Item A. in Item Number 6., and you are in HHS custody, did the juvenile
Yes
No
court order determine or alter your custody status or placement?
Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition
Prospective Employer Attestation
1.
Provide the following information about the prospective employer.
A. Number of members of the prospective employer's organization
B. Number of employees working at the same location where the beneficiary will be employed
C. Number of aliens holding special immigrant or nonimmigrant religious worker status who are currently
employed or were employed within the past five years
D. Number of Special Immigrant Religious Worker (Form I-360) and Nonimmigrant Religious Worker
(Form I-129) petitions submitted by the prospective employer within the past five years
E. Number of Special Immigrant Religious Worker (Form I-360) petitions submitted by the beneficiary
during the last five years
2.
Has the beneficiary or have any of the beneficiary's dependent family members previously been admitted
Yes
No
to the United States for a period of stay in the Religious Worker (R) classification during the last five
years?
If you answered "Yes" to Item Number 2., provide the beneficiary's and any dependent family member's prior periods of stay in
the R classification in the United States during the last five years. Be sure to provide only those periods when the beneficiary
and/or family members were actually in the United States in the R classification. Provide the beneficiary's information in Item
Number 3. below. For dependent family members, use the space provided in Part 15. Additional Information.
NOTE: Submit photocopies of Form I-94 Arrival-Departure Record, Form I-797 (Notice of Action), and/or other USCIS
documents identifying these periods of stay in the R classification. If you need extra space to complete this section, use the
space provided in Part 15. Additional Information.
Form I-360 12/23/16 N
Page 9 of 19
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