Form I-192 - Application For Advance Permission To Enter As A Nonimmigrant Page 3
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8Part 2. Information About You (continued)
D.
Residence Number 4
Date of Residence From (mm/dd/yyyy)
To (mm/dd/yyyy)
Street Number and Name
Apt.
Ste.
Flr.
Number
City or Town
State
ZIP Code
Province
Postal Code
Country
Travel Information
9.
Location at which you plan to enter the United States (desired Port-of-Entry)
City
State
10. Name of Port-of-Entry
11. How do you plan to travel to the United States? (For example, by plane, ship, car)
12.
When do you plan to enter the United States?
(mm/dd/yyyy)
13.
Approximate Length of Stay in the United States
14.
What is the purpose of your stay in the United States? Explain fully below.
Immigration and Criminal History
Yes
No
15.
Do you believe that you may be inadmissible to the United States?
If you answered "Yes," explain the reasons why you believe, according to the best of your knowledge, that you may be
inadmissible in Part 7. Additional Information. If you were told that you are inadmissible, provide the reason you were given.
16.
Have you previously filed an application for advance permission to enter the United States as a
Yes
No
nonimmigrant?
If you answered “Yes,” provide the details in Items A. - C. in Item Number 17. If you need extra space to complete this section,
use the space provided in Part 7. Additional Information.
17.
A.
Date Application Filed
(mm/dd/yyyy)
B.
Location where you filed your application (For example, U.S. Citizenship and Immigration Services (USCIS) Office or
Port-of-Entry)
USCIS Office or U.S. Port-of-Entry
City or Town
State or Province
Country
►
C. Receipt Number (if available)
Form I-192 12/23/16 N
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