Form I-914 Instructions For Application For T Nonimmigrant Status (Page 5 of 14) in pdf

Part D. Information About Your Family Member (the derivative)

1. Full Name. Provide the name of the family member, as shown on his or her birth certificate or legal change of name

document. If the person has two last names, include both and use a hyphen (-) between the names, if appropriate.

Write the person’s last, first, and middle names in each appropriate field.

2. Other Names Used. Provide all the names he or she has used, including maiden name, if applicable, married names,

nicknames, etc.

3. Residence or Intended Address in the United States. Give his or her intended 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 his or her mailing address, if different from his or her intended home address. If he or

she does not feel secure in receiving correspondence regarding this application at his or her home address, provide a

“safe mailing address” in this space. This address may be a post office box, the address of a friend, your/his or her

attorney, a community-based organization, or any other address where he or she can safely and punctually receive

mail.

5. Home Telephone Number. Give the telephone number with area code where he or she lives and can be reached

during the day.

6. Safe Daytime Telephone Number. If he or she does not feel secure receiving telephone calls regarding this

application at his or her home, provide a “safe telephone number” in this space. This number may be for a friend,

his or her attorney, a community-based organization, or any other number where he or she can safely and punctually

receive a call or a message.

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 his or her USCIS (former INS) file number. If he or she does not have an A-Number or you do

not know it, leave this blank.

9. U.S. Social Security Number. If he or she does not have a U.S. 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 his or her date of birth (example: May 1, 1979, should be written

05/01/1979).

12. Country of Birth. Give the name of the country where he or she was born. Include the city, state or province, and

country.

13. Country of Citizenship. Give the name of the country where he or she is a citizen. This is not necessarily the

country where he or she was born.

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

or her passport was issued. Give the date when his or her passport was issued.

15. Last Entry Into the United States. Give the date and place where he or she last entered the United States, regardless

of whether that entry was legal or illegal.

16. Form I-94, Arrival-Departure Document Number. If physically present in the United States, 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.).

18. Previously Traveled to the United States. Give the following information about your family member if he or she

has previously traveled to the United States.

Form I-914 Instructions 02/27/17 Y

Page 5 of 14

Form I-914 Instructions For Application For T Nonimmigrant Status Page 5