Form I-918 - Supplement A - Petition For Qualifying Family Member Of U-1 Recipient Page 7
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1229.c.
Is your family member NOW or has your family member
Part 5. Processing Information (continued)
EVER been a drug abuser or drug addict?
18.
Has your family member EVER been removed, excluded,
Yes
No
or deported from the United States?
Yes
No
19.
Has your family member EVER been ordered to be
Part 6. Information About Your Qualifying
removed, excluded, or deported from the United States?
Family Member's Spouse and/or Children
Yes
No
Provide the following information about your family member's
20.
Has your family member EVER been denied a visa or
spouse and/or children. If you need extra space to complete this
denied admission to the United States?
section, use the space provided in Part 11. Additional
Yes
No
Information.
21.
Has your family member EVER been granted voluntary
1.a. Family Name
departure by an immigration officer or an immigration
(Last Name)
judge and failed to depart within the allotted time?
1.b. Given Name
Yes
No
(First Name)
1.c. Middle Name
22.
Is your family member NOW under a final order or civil
penalty for violating section 274C of the INA (producing
2.
Date of Birth (mm/dd/yyyy)
and/or using false documentation to unlawfully satisfy a
requirement of the INA)?
Yes
No
3.
Country of Birth
23.
Has your family member EVER, by fraud or willful
misrepresentation of a material fact, sought to procure or
4.
Relationship
procured a visa or other documentation, for entry into the
United States or any immigration benefit?
Yes
No
5.a.
Family Name
(Last Name)
24.
Has your family member EVER left the United States to
5.b.
avoid being drafted into the U.S. Armed Forces or U.S.
Given Name
(First Name)
Coast Guard?
Yes
No
5.c.
Middle Name
25.
Has your family member EVER been a J nonimmigrant
exchange visitor who was subject to the 2-year foreign
6.
Date of Birth (mm/dd/yyyy)
residence requirement and not yet complied with that
7.
requirement or obtained a waiver of such?
Country of Birth
Yes
No
26.
Has your family member EVER detained, retained, or
8.
Relationship
withheld the custody of a child, having a lawful claim to
United States citizenship, outside the United States from a
United States citizen granted custody?
Yes
No
9.a. Family Name
(Last Name)
27.
Does your family member plan to practice polygamy in
the United States?
9.b. Given Name
Yes
No
(First Name)
28.
Has your family member EVER entered the United States
9.c. Middle Name
as a stowaway?
Yes
No
10.
Date of Birth (mm/dd/yyyy)
29.a.
Does your family member NOW have a communicable
disease of public health significance?
11.
Country of Birth
Yes
No
29.b.
Does your family member NOW have or has your family
member EVER had a physical or mental disorder and
12.
Relationship
behavior (or a history of behavior that is 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?
Yes
No
Page 7 of 12
Form I-918 Supplement A 02/07/17 N
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