Form I-821 - Application For Temporary Protected Status Page 3
Download a blank fillable Form I-821 - Application For Temporary Protected Status in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form I-821 - Application For Temporary Protected Status with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13Part 2. Information About You (continued)
Your Current Immigration Status
31.
Current Immigration Status or Lack of Status
18.
Date of Current Marriage (if currently married)
(mm/dd/yyyy)
32.
Are you now or were you EVER in immigration
U.S. Entry Information
proceedings?
Yes
No
19.
Date of Last Entry into the United States
If you answered "Yes" to Item Number 32., provide the
(mm/dd/yyyy)
following information.
20.
Immigration Status (or Lack of Status) When You Last
Type of Proceedings (Select all boxes that apply):
Entered the United States (for example, visitor, student,
33.a.
Immigration Court (before an Immigration Judge)
no status)
33.b.
Board of Immigration Appeals (BIA)
33.c.
I am no longer in Department of Justice (DOJ) or
Place of Last Entry into the United States
Department of Homeland Security (DHS)
immigration proceedings, but I am or was in Federal
21.
U.S. Port of Entry (if any)
court proceedings regarding immigration issues.
34.
Locations Where Your DOJ and/or DHS Proceedings
22.a. City or Town
were Held (or are currently being held) (if applicable)
35.
Locations Where Your Federal Court Proceedings
22.b. State
Regarding Immigration Issues were Held (or are currently
being held) (if applicable)
23.
Form I-94 Arrival-Departure Record Number (if any)
►
24.
Date Your Authorized Period of Stay in the United States
Dates for Your Proceedings
Expired or Will Expire (as shown on Form I-94 or
Crewman's Landing Permit (Form I-95)) (mm/dd/yyyy or
NOTE: If your proceedings are ongoing, leave the “To” date
duration of status (D/S)
blank. If you have been in more than one type of proceedings,
or in Federal Court, list dates for each time period.
25.
Passport Number (most recent passport) (if any) (If you
36.a.
From (mm/dd/yyyy)
have other expired or valid passports, please list all of
them and provide all information requested below about
36.b.
To (mm/dd/yyyy)
each passport.)
36.c.
Present
26.
Travel Document Number (if any)
Part 3. Biographic Information
27.
Additional Passport or Travel Document Number
1.
Ethnicity (Select only one box)
Hispanic or Latino
28.
Additional Passport or Travel Document Number
Not Hispanic or Latino
2.
Race (Select all applicable boxes)
29.
Country of Issuance for most recent Passport or Travel
White
Document
Asian
Black or African American
30.
Expiration Date for most recent Passport or Travel
American Indian or Alaska Native
Document (mm/dd/yyyy)
Native Hawaiian or Other Pacific Islander
Form I-821 10/19/17 N
Page 3 of 13
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form I-821 - Application For Temporary Protected Status - U.s. Citizenship And Immigration Services
Legal
Form I-687 - Application For Status As A Temporary Resident Under Section 245a Of The Immigration And Nationality Act
Legal
Form I-687 - Application For Status As A Temporary Resident Under Section 245a Of The Immigration And Nationality Act
Legal
Related Categories
Parent category: Legal