Form I-914 - Application For T Nonimmigrant Status
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9OMB No. 1615-0099
Department of Homeland Security
I-914, Application for T Nonimmigrant Status
U.S. Citizenship and Immigration Services
START HERE - Type or print.
For USCIS Use Only
Use black ink. See Instructions for information
about eligibility and how to complete and file this application.
Receipt
Returned
PART A. Purpose for Filing the Application
Date
Check all that apply:
Date
I am filing an application for T-1 nonimmigrant status, and have not previously
Resubmitted
filed for such status.
I have a T-1 application pending. EAC #:
Date
I have received T-1 status.
Date
I am applying to bring family member(s) to the United States.
Reloc Sent
PART B. General Information About You (Person filing this form as a victim)
Date
Family Name (Last Name)
Given Name (First Name)
Middle Name (if any)
Date
Reloc Rec'd
Other Names Used (Include maiden name/nickname)
Date
Home Address - Street Number and Name
Apt. #
Date
Validity Dates
City
State/Province
Zip/Postal Code
From:
To:
Remarks
Safe Mailing Address (if other than above) - Street Number and Name
Apt. #
C/O (in care of):
City
State/Province
Zip/Postal Code
Home Telephone #
Safe Daytime Phone #
E-Mail Address
Conditional Approval
(with area code)
(with area code)
(optional)
Stamp #
Date
Action Block
A # (if any)
U.S. Social Security # (if any)
Gender
Male
Female
Marital Status:
Married
Single/Never Married
Divorced
Widowed
Date of Birth (mm/dd/yyyy)
Country of Birth
Country of Citizenship
Passport #
Place of Issuance
Date of Issue (mm/dd/yyyy)
To Be Completed by
Attorney or Representative, if any
Place of Last Entry
Date of Last Entry (mm/dd/yyyy)
Fill in box if G-28 is attached to
represent the applicant.
I-94 # (Arrival/Departure Document)
Current Immigration Status
ATTY State License #
Form I-914 (Rev. 02/01/11) Y
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