Form I-192 - Application For Advance Permission To Enter As A Nonimmigrant Page 4
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8Part 2. Information About You (continued)
NOTE: If you are an applicant for T nonimmigrant status or a petitioner for U nonimmigrant status, you do not need to
answer Item Numbers 18. - 21.
Yes
No
18.
Have you EVER been in the United States for a period of six months or more?
If you answered “Yes,” provide the dates you were in the United States (from and to) and your immigration status at the time of
entry into the United States in the space provided in Part 7. Additional Information.
19.
Have you EVER filed an application or petition for immigration benefits with the U.S. Government, or has
Yes
No
one ever been filed on your behalf?
If you answered “Yes” to Item Number 19. provide the information in the space provided in Part 7. Additional Information.
NOTE: If you (or somebody else on your behalf) have filed multiple applications or petitions for immigration benefits with the
U.S. Government, use the space provided in Part 7. to also provide the following information:
A.
Type of application or petition filed;
B.
Location where you (or the other person) filed the application or petition (for example, USCIS office or Port-of-Entry);
C. Outcome of the application or petition (for example, approved, denied, or is pending)
20.
Have you EVER been denied or refused an immigration benefit by the U.S. Government, or had a benefit
Yes
No
revoked or terminated (including but not limited to visas)?
If you answered “Yes” to Item Number 20., provide the information in the space provided in Part 7. Additional Information.
21. Have you EVER, in or outside the United States, been arrested, cited, charged, indicted, fined, convicted,
Yes
No
or imprisoned for breaking or violating any law or ordinance, excluding minor traffic violations? If you
answered “Yes,” describe the incidents in detail and include all offenses where impaired driving may have
been an issue in the space provided in Part 7. Additional Information.
Part 3. Biographic Information
1.
Ethnicity (Select only one box)
Hispanic or Latino
Not Hispanic or Latino
2.
Race (Select all applicable boxes)
White
Asian
Black or African
American Indian or
Native Hawaiian or
American
Alaska Native
Other Pacific Islander
3.
Height
Feet
Inches
4.
Weight
Pounds
5.
Eye Color (Select only one box)
Black
Blue
Brown
Gray
Green
Hazel
Maroon
Pink
Unknown/
Other
6.
Hair Color (Select only one box)
Black
Blond
Brown
Gray
Red
Sandy
White
Bald
Unknown/
(No hair)
Other
Form I-192 12/23/16 N
Page 4 of 8
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