Form I-914 - Application For T Nonimmigrant Status
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10USCIS
Application for T Nonimmigrant Status
Form I-914
Department of Homeland Security
OMB No. 1615-0099
U.S. Citizenship and Immigration Services
Expires 01/31/2019
START HERE - Type or print.
Use black ink. See Instructions for information
For USCIS Use Only
about eligibility and how to complete and file this application.
Receipt
Returned
PART A. Purpose for Filing the Application
Date
Check all that apply:
Date
I am filing for T-1 nonimmigrant status and have not previously filed for such
Resubmitted
status.
Date
I am filing for T-1 nonimmigrant status and have previously filed for such status.
Receipt Number (begins with EAC)
Date
Reloc Sent
I have received T-1 status and am applying to bring family members to the United
States.
Date
Date
PART B. General Information About You (Person filing this form as a victim)
Reloc Rec'd
Family Name (Last Name)
Given Name (First Name)
Middle Name (if any)
Date
Date
Other Names Used (Include maiden name/nickname)
Validity Dates
Home Address - Street Number and Name
Apt. Number
From:
To:
City
State/Province
Zip/Postal Code
Remarks
Safe Mailing Address (if other than above) - Street Number and Name
Apt. Number
C/O (in care of):
City
State/Province
Zip/Postal Code
Conditional Approval
Home Telephone Number
Safe Daytime Phone Number
(with area code)
(with area code)
Stamp #
Date
Action Block
E-Mail Address (optional)
A-Number (if any)
U.S. Social Security Number (if any)
Gender
Male
Female
Marital Status:
Divorced
Widowed
Single/Never Married
Married
Date of Birth (mm/dd/yyyy)
Country of Birth
Country of Citizenship
Passport Number
Place of Issuance
Date of Issue (mm/dd/yyyy)
To Be Completed by
Attorney or Representative, if any
Place of Last Entry
Date of Last Entry (mm/dd/yyyy)
Fill in box if G-28 is attached to
represent the applicant.
ATTY State
Form I-94 Number (Arrival-Departure Record)
Current Immigration Status
License #
Page 1
Form I-914 02/27/17 Y
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