Form I-914 Instructions For Application For T Nonimmigrant Status (Page 3 of 14) in pdf

7. E-Mail Address. This is optional. If you do not have an e-mail address or feel that your e-mail address is not secure,

write “None.”

8. A-Number. This is your USCIS (former INS) file number. If you do not have an A-Number or do not know it, leave

this blank.

9. U.S. Social Security Number. If you do not have a Social Security Number, leave this blank.

10. Gender and Marital Status. Check the appropriate box for each.

11. Date of Birth. Use eight numbers to show your date of birth (example: May 1, 1979, should be written (05/01/1979)

12. Country of Birth. Give the name of the country where you were born. Include the city, state or province, and

country.

13. Country of Citizenship. Give the name of the country where you are a citizen. This is not necessarily the country

where you were born.

14. Passport. Give the number of the passport used to enter the United States, if applicable. Give the location where

your passport was issued. Give the date when your passport was issued.

15. Last Entry Into the United States. Give the date and place where you last entered the United States, regardless of

whether that entry was legal or illegal.

16. Form I-94, Arrival-Departure Document Number. If applicable, give the number on Form I-94 issued at the time

of entry.

17. Current Immigration Status. Give your current status, regardless of how you entered the United States (visitor,

student, entry without inspection, etc.).

Part C. Additional Information

You must answer each question. You must explain relevant information about your claim. Attach documents in support

of your claim and the specific facts on which you are relying to support your claim.

Complete Question 10 to indicate whether you would like an Employment Authorization Document (EAD). If your

application is approved, you will be authorized to work. USCIS will send you an EAD as evidence of your authorization

to work if you indicate “Yes” for Question 10. As the principal applicant you do not need to file a Form I-765,

Application for Employment Authorization Document.

Complete Question 11 to indicate whether you are applying for one or more eligible family members at this time. See the

section below entitled “Completing Form I-914 Supplement A, Application for a Family Member T-1 Recipient,” for

information on completing an application on behalf of your eligible family member.

Part D. Processing Information

You must answer each question. If you answer “Yes” to any of the questions, explain on a separate sheet of paper.

Explain if any of the acts or circumstances relate to your having been a victim of a severe form of trafficking in persons.

Part E. Information about Your Family Members

Even if you are not applying to bring your family members to the United States, you must provide the requested

information about your spouse and children, if any.

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

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.

Form I-914 Instructions 02/27/17 Y

Page 3 of 14

Form I-914 Instructions For Application For T Nonimmigrant Status Page 3