Instructions For Application For Replacement Naturalization/citizenship Document (Form N-565) (Page 4 of 7) in pdf

C. Physician’s Drug Enforcement Administration registration number or comparable foreign registration number (if

applicable);

D. Language stating that the individual has had appropriate clinical treatment for gender transition to the new gender

(male or female); and

E. Language stating you have a doctor-patient relationship with the certifying physician and that he or she has treated

you in relation to your change in gender or has reviewed and evaluated your medical history in relation to your

change in gender.

NOTE: Statements from persons who are not licensed physicians, such as psychologists, physician assistants, nurse

practitioners, social workers, health practitioners, chiropractors, are not acceptable. Visit

for

additional information.

7. If you are applying for a special certificate of naturalization to obtain recognition as a citizen of the United States by a

foreign country, you must attach a copy of your naturalization certificate.

NOTE: USCIS regulations require this special certificate when a foreign state requires proof of your citizenship for

any legitimate purpose, except for admission to the foreign country or in processing their own immigration benefit

requests. (Regulation is 8 CFR 343b.2.)

8. If your marital status has changed since you were last issued a document, you must submit your most recent marriage

certificate, divorce decree, or spouse’s death certificate.

Specific Instructions

Part 9. Applicant’s Statement, Contact Information, Certification, and Signature

Item Numbers 1. - 6. Select the appropriate box to indicate whether you read this application yourself or whether you

had an interpreter assist you. If someone assisted you in completing the application, select the box indicating that you

used a preparer. Further, you must sign and date your application and provide your daytime telephone number, mobile

telephone number (if any), and email address (if any). Every application MUST contain the signature of the applicant (or

parent or legal guardian, if applicable). A stamped or typewritten name in place of a signature is not acceptable.

Part 10. Interpreter’s Contact Information, Certification, and Signature

Item Numbers 1. - 7. If you used anyone as an interpreter to read the Instructions and questions on this application to

you in a language in which you are fluent, the interpreter must fill out this section, provide his or her name, the name and

address of his or her business or organization (if any), his or her daytime telephone number, his or her mobile telephone

number (if any), and his or her email address (if any). The interpreter must sign and date the application.

Part 11. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than

the Applicant

Item Numbers 1. - 8. This section must contain the signature of the person who completed your application, if other

than you, the applicant. If the same individual acted as your interpreter and your preparer, that person should complete

both Part 10. and Part 11. If the person who completed this application is associated with a business or organization,

that person should complete the business or organization name and address information. Anyone who helped you

complete this application MUST sign and date the application. A stamped or typewritten name in place of a signature

is not acceptable. If the person who helped you prepare your application is an attorney or accredited representative, he

or she may be obliged to also submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited

Representative, along with your application.

Form N-565 Instructions 06/13/17 N

Page 4 of 7

Instructions For Application For Replacement Naturalization/citizenship Document (Form N-565) Page 4