Form I-821 - Application For Temporary Protected Status Page 4
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13Part 3. Biographic Information (continued)
Mailing Address of Spouse
4.a. Street Number
3.
Height
Feet
Inches
and Name
4.
Weight
Pounds
4.b.
Apt.
Ste.
Flr.
5.
Eye Color (Select only one box)
4.c. City or Town
Black
Blue
Brown
4.d. State
4.e. ZIP Code
Gray
Green
Hazel
4.f.
Province
Maroon
Pink
Unknown/Other
4.g. Postal Code
4.h. Country
6.
Hair Color (Select only one box)
Bald (No hair)
Black
Blond
Brown
Gray
Red
Other Information About Your Current Spouse
Sandy
White
5.
Your Spouse's Date of Birth
Unknown/Other
(mm/dd/yyyy)
6.
Date of Marriage to Your Current Spouse
Part 4. Information About Your Current Spouse
(mm/dd/yyyy)
(if any)
7.
Place of Marriage to Your Current Spouse
Complete this section only if you are filing a late initial
application for TPS. See the form instructions for information
on requirements for late initial filing for TPS. If you need extra
8.a. City or Town
space to complete this section on all former spouses and all of
your children, please use the space provided in Part 11.
8.b. State
Additional Information.
Provide the following information about your current spouse (if
8.c. Province (if any)
married).
8.d. Country
1.
USCIS Online Account Number (if any and if known)
►
9.
If you know, has your current spouse EVER had TPS?
2.
A-Number (if any and if known)
Yes
No
►
A-
If yes, what dates did he or she have TPS?
3.a. Family Name
(Last Name)
10.a.
From (mm/dd/yyyy)
3.b. Given Name
(First Name)
10.b.
To (mm/dd/yyyy)
3.c. Middle Name
10.c.
Present
10.d.
I do not know the dates
11.
Is your spouse's TPS still valid? (if known)
Yes
No
I Do Not Know
Form I-821 10/19/17 N
Page 4 of 13
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