Form I-914 Instructions For Application For T Nonimmigrant Status (Page 2 of 14) in pdf

C. Regardless of your age at the time of filing, if your family member faces a present danger of retaliation, as a

result of your escape from the severe form of trafficking in persons or your cooperation with law enforcement, the

eligible family members for whom you may file are your:

(1) Parent(s);

(2) Unmarried sibling(s) under 18 years of age; or

(3) An adult or minor child of your derivative (your grandchild, your spouse’s child, your niece or nephew, or

your sibling).

General Instructions

Fill Out Form I-914, Form I-914, Supplement A, and Form I-914, Supplement B (optional)

1. Type or print legibly in black ink.

2. If extra space is needed to complete any item, attach a continuation sheet, write your name and A-Number (if any),

indicate the item number, and date and sign each sheet.

3. Answer all questions fully and accurately, unless instructed to leave a part blank. State that an item is not applicable

with “N/A.” If the answer is none, write “None.”

Completing Form I-914

You, as the principal applicant, must file Form I-914 for yourself.

This form is divided into Parts A. - H. The following information will help you fill out the form.

Part A. Purpose for Filing the Application - Check all the appropriate boxes that apply to why you filed this

application.

Part B. General Information About You (person filing this application as a victim of a severe form of trafficking in

persons)

1. Your Full Name. Provide your legal name, as shown on your birth certificate or legal name change document. If you

have two last names, include both and use a hyphen (-) between the names, if appropriate. Write your last, first, and

middle names in each appropriate field.

2. Other Names Used. Provide all the names you have used, including maiden name if applicable, married names,

nicknames, etc.

3. Home Address. Give your physical street address. This must include a street number and name or a rural route

number. Do not put a post office box (P.O. Box) number here.

4. Safe Mailing Address. Give your mailing address, if different from your home address. If you do not feel secure in

receiving correspondence regarding this application at your home address, provide a “safe mailing address” in this

space. This address may be a post office box, the address of a friend, your attorney, a community-based organization

that is helping you, or any other address where you can safely and punctually receive mail.

5. Home Telephone Number. Give the phone number with area code. If you live outside the United States, give the

country and city code.

6. Safe Daytime Telephone Number. If you do not feel secure in receiving telephone calls regarding this application

at your home telephone number, provide a “safe telephone number” in this space. This number may be for a friend,

your attorney, a community-based organization that is helping you, or any other number where you can safely and

punctually receive a call or a message.

Form I-914 Instructions 02/27/17 Y

Page 2 of 14

Form I-914 Instructions For Application For T Nonimmigrant Status Page 2