Form I-914 - Application For T Nonimmigrant Status Page 6

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PART D. Processing Information (continued)
12. Have you EVER been a member of, assisted in, or participated in any group, unit, or organization of any kind
Yes
No
in which you or other persons used any type of weapon against any person or threatened to do so?
13. Have you EVER assisted or participated in selling or providing weapons to any person who to your
Yes
No
knowledge used them against another person, or in transporting weapons to any person who to your
knowledge used them against another person?
14. Have you EVER received any type of military, paramilitary, or weapons training?
Yes
No
15. Are you under a final order or civil penalty for violating section 274C (producing and/or using false
Yes
No
documentation to unlawfully satisfy a requirement of the Immigration and Nationality Act)?
16. Have you EVER, by fraud or willful misrepresentation of a material fact, sought to procure, or procured, a
Yes
No
visa or other documentation, for entry into the United States or any immigration benefit?
17. Have you EVER left the United States to avoid being drafted into the U.S. Armed Forces?
Yes
No
18. Have you EVER been a J nonimmigrant exchange visitor who was subject to the two-year foreign residence
Yes
No
requirement and not yet complied with that requirement or obtained a waiver of such?
19. Have you EVER detained, retained, or withheld the custody of a child, having a lawful claim to U.S.
Yes
No
citizenship, outside the United States from a U.S. citizen granted custody?
20. Do you plan to practice polygamy in the United States?
Yes
No
21. Have you entered the United States as a stowaway?
Yes
No
22. a. Do you have a communicable disease of public health significance?
Yes
No
b. Do you have or have you had a physical or mental disorder and behavior (or a history of behavior that is
Yes
No
likely to recur) associated with the disorder which has posed or may pose a threat to the property, safety,
or welfare of yourself or others?
c. Are you now or have you been a drug abuser or drug addict?
Yes
No
PART E. Information About Your Family Members
Provide the following information about your spouse and all of your sons and daughters. If you need more space, attach an additional
sheet of paper.
Spouse
1.
Family Name (Last Name)
Given Name (First Name)
Middle Name (if any)
Date of Birth (mm/dd/yyyy)
Country of Birth
Current Location
Page 6
Form I-914 02/27/17 Y

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