Form I-751 - Petition To Remove Conditions On Residence Page 5
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11Part 5. Information About Your Children
Part 6. Accommodations for Individuals With
(continued)
Disabilities and/or Impairments
NOTE: Read the information in the Form I-751 Instructions
Physical Address
before completing this part.
24.a.
Street Number
1.
Are you requesting an accommodation because of your
and Name
disabilities and/or impairments?
Yes
No
24.b.
Apt.
Ste.
Flr.
2.
Are you requesting an accommodation because of your
24.c. City or Town
spouse's disabilities and/or impairments?
Yes
No
24.d. State
24.e. ZIP Code
3.
Are you requesting an accommodation because of your
24.f.
Province
included children's disabilities and/or impairments?
Yes
No
24.g.
Postal Code
If you answered "Yes" to Item Numbers 1. - 3., select any
24.h. Country
applicable box for Item Numbers 4.a. - 4.c. Provide
information on the disabilities and/or impairments for each
person.
Child 5
4.a.
I am deaf or hard of hearing and request the
25.a.
Family Name
following accommodation. (If you are requesting a
(Last Name)
sign-language interpreter, indicate for which
25.b.
Given Name
language (for example, American Sign Language).):
(First Name)
25.c.
Middle Name
26.
Date of Birth (mm/dd/yyyy)
27.
A-Number (if any)
4.b.
I am blind or have low vision and request the
►
following accommodation:
A-
28.
Is this child living with you?
Yes
No
29.
Is this child applying with you?
Yes
No
4.c.
I have another type of disability and/or impairment.
Physical Address
(Describe the nature of your disability and/or
impairment and the accommodation you are
30.a.
Street Number
requesting.):
and Name
30.b.
Apt.
Ste.
Flr.
30.c. City or Town
30.d. State
30.e. ZIP Code
30.f.
Province
30.g.
Postal Code
30.h. Country
Form I-751 12/23/16 N
Page 5 of 11
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