Form I-698 - Application To Adjust Status From Temporary To Permanent Resident Page 3
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6Have you ever been charged with committing any crime or offense?
Yes
No
Have you ever been convicted of a crime or offense?
Yes
No
Have you ever been in jail or prison?
Yes
No
Have you ever been placed in an alternative sentencing or a rehabilitative program (for example:
Yes
No
diversion, deferred prosecution, withheld adjudication, deferred adjudication)?
Have you ever received a suspended sentence, been placed on probation, or been paroled?
Yes
No
20. Have you, or a dependent member of your immediate family, ever received public assistance from any
Yes
No
source, including, but not limited to, the U.S. Government, any State, county, city, or municipality? If
"Yes" provide the names(s) of the recipients(s) and U.S. Social Security Number(s).
Name of Recipient (Family Name, Given Name, Middle Name)
U.S. Social Security Number
21. Have you ever:
a. Within the past 10 years been a prostitute or procured anyone for prostitution, or intend to engage in
Yes
No
such activities in the future?
b. Engaged in any unlawful commercialized vice, including, but not limited to, illegal gambling?
Yes
No
c. Knowingly encouraged, induced, assisted, abetted, or aided any alien to try to enter the United States
Yes
No
illegally?
d. Illicitly trafficked in any controlled substance, or knowingly assisted, abetted, or colluded in the illicit
Yes
No
trafficking of any controlled substance?
22. Have you ever engaged in, conspired to engage in, or do you intend to engage in, or have you ever
Yes
No
solicited membership or funds for, or have you through any means ever assisted or provided any type of
material support to any person or organization that has ever engaged or conspired to engage in sabotage,
kidnapping, political assassination, hijacking, or any other form of terrorist activity?
23. Do you intend to engage in the United States in:
a. Espionage?
Yes
No
b. Any activity a purpose of which is opposition to, or the control or overthrow of, the Government of
Yes
No
the United States, by force, violence, or other unlawful means?
c. Any activity to violate or evade any law prohibiting the export from the United States of goods,
Yes
No
technology, or sensitive information?
24. Have you ever been a member of, or in any way affiliated with, a Communist Party or any other
Yes
No
totalitarian party?
Form I-698 (Rev. 01/12/11) Y Page 3
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Parent category: Legal