Form I-698 - Application To Adjust Status From Temporary To Permanent Resident Page 2
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614. Absences from the United States since becoming a temporary resident alien. List most recent absence first. If you have a single
absence in excess of 30 days or if the total of all your absences exceeds 90 days, explain and attach any relevant information.
From
To
Total Days
Country
Purpose of Trip
(mm/dd/yyyy)
(mm/dd/yyyy)
Absent
15. When applying for temporary resident status, I did
did not
submit a Form I-693, Medical Examination of Aliens Seeking
Adjustment of Status, with my application that included a serologic (blood) test for human immunodeficiency virus (HIV)
infection. (If you did not, submit Form I-693 that includes a serologic test for HIV.)
16. Concerning the requirement of minimal understanding of ordinary English and a knowledge and understanding of the history and
Government of the United States (check appropriate block under Section A or B):
A. I will satisfy these requirements by:
Examination at the time of interview for permanent residence.
Satisfactorily pursuing a course of study recognized by the Secretary of Homeland Security.
B. I have satisfied these requirements by:
Having satisfactorily pursued a course of study recognized by the Secretary of Homeland Security. (Attach appropriate
documentation.)
Exemption because I am 65 years of age or older, under 16 years of age, or I am physically unable to comply. (If you are
physically unable to comply, explain and attach relevant documentation.)
If you answer "Yes" to any of the questions numbered 17 through 37, explain your answer on a separate sheet of paper.
17. Have you ever assisted in the persecution of any person or persons on account of race, religion, political
Yes
No
opinion, nationality, or membership in a particular social group?
18. Have you ever been treated for a mental disorder, drug addiction, or alcoholism?
Yes
No
19. Have you ever committed a crime or offense for which you were not arrested?
Yes
No
Have you ever been arrested, cited, or detained by any law enforcement officer (including Immigration
Yes
No
and Customs Enforcement (ICE), Customs and Border Protection (CBP), former Immigration and
Naturalization Service (INS), and/or military officers) for any reason?
Form I-698 (Rev. 01/12/11) Y Page 2
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