Form I-800a - Application For Determination Of Suitability To Adopt A Child From A Convention Country Page 2

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Part 1.
Information About You
(Continued)
4. I am:
A citizen of the United States. I obtained my U.S. citizenship through:
Birth in the United States
Parent(s)
Naturalization
Not a citizen of the United States. STOP. You may not file this application (see Pages 1 to 2 of instructions for eligibility to
file).
5. If you derived or acquired citizenship through your parent(s), have you obtained your own certificate of
Yes
No
citizenship?
If "Yes," provide the following information:
Name Under Which Certificate of Citizenship Was Issued
Certificate of
Date of Issuance
Place of
A #
Citizenship Number
(mm/dd/yyyy)
Issuance
(if known)
6. If you became a citizen by naturalization, give the following information:
Name Under Which Certificate of Naturalization Was Issued
Naturalization
Date of Naturalization
Place of
A #
Certificate Number
(mm/dd/yyyy)
Naturalization
(if known)
7. Have you, or any person through whom you claimed citizenship, ever lost U.S. citizenship?
Yes
No
If "Yes," attach a detailed explanation including date, place, and circumstances on a separate
sheet of paper.
8. Provide the following information about your current marital status.
a. I am:
Single, never married.
Single, with all previous marriages terminated. (If you check this box, you must complete 8,c.)
Married, with no previous marriages. (If you check this box, you must complete 8,b.)
Married, with all previous marriages terminated. (If you check this box, you must complete 8,b, and c.)
b. If married, provide the following information:
Date of Current Marriage
Place of Current Marriage
(mm/dd/yyyy)
(City/Town, State/Province, Country)
Form I-800A (Rev. 03/10/17) N Page 2

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