Form I-918 - Supplement A - Petition For Qualifying Family Member Of U-1 Recipient Page 3
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126.a. Family Name
Part 4. Additional Information About Your
(Last Name)
Qualifying Family Member (continued)
6.b. Given Name
(First Name)
If your family member is outside the United States, provide
the U.S. Consulate or inspection facility or a safe foreign
6.c. Middle Name
mailing address you want notified if this supplement is
approved.
6.d.
Date Marriage Ended (mm/dd/yyyy)
3.a.
Type of Office (Select only one box):
6.e. Where did the marriage end?
Pre-Flight Inspection
U.S. Consulate
Port-of-Entry
6.f.
How did the marriage end?
3.b.
City or Town
Other Information
3.c.
State
3.d.
Country
7.a. Your family member was or is in immigration
proceedings.
Yes
No
If you answered "Yes," select the type of proceedings. If your
Safe Foreign Address Where You Want Notification Sent
family member was in proceedings in the past and is no longer
(if other than U.S. Consulate, Pre-Flight Inspection, or
in proceedings, provide the date of action. If your family
Port-of-Entry)
member is currently in proceedings, type or print “Current” in
4.a.
the appropriate date field. Select all applicable boxes. Use the
Street Number
and Name
space provided in Part 11. Additional Information to provide
an explanation.
4.b.
Apt.
Ste.
Flr.
7.b.
Removal Proceedings
4.c.
City or Town
Removal Date (mm/dd/yyyy)
4.d.
Province
7.c.
Exclusion Proceedings
Exclusion Date (mm/dd/yyyy)
4.e.
Postal Code
7.d.
Deportation Proceedings
4.f.
Country
Deportation Date (mm/dd/yyyy)
7.e.
Rescission Proceedings
If your family member was previously married, list the
Rescission Date (mm/dd/yyyy)
names of your family member's prior spouses and the dates
his or her marriages were terminated. You must attach
7.f.
Judicial Proceedings
documents such as divorce decrees or death certificates.
Judicial Date (mm/dd/yyyy)
5.a. Family Name
8.
Your family member would like an Employment
(Last Name)
Authorization Document.
Yes
No
5.b. Given Name
(First Name)
NOTE: If you answered "Yes," submit Form I-765,
5.c. Middle Name
Application for Employment Authorization Document,
separately. If your family member is living outside the
5.d.
Date Marriage Ended (mm/dd/yyyy)
United States, he or she is not eligible to receive
employment authorization until he or she is lawfully
5.e. Where did the marriage end?
admitted to the United States. Do not file Form I-765 for
a family member living outside the United States.
5.f.
How did the marriage end?
Page 3 of 12
Form I-918 Supplement A 02/07/17 N
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