Form I-914 - Application For T Nonimmigrant Status Page 6
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9PART D. Processing Information
(Continued)
12. Have you EVER:
a. Served in, been a member of, assisted in, or participated in any military unit, paramilitary unit, police unit,
Yes
No
self-defense unit, vigilante unit, rebel group, guerrilla group, militia, or insurgent organization?
b. Served in any prison, jail, prison camp, detention facility, labor camp, or any other situation that involved
Yes
No
detaining persons?
Yes
No
13. Have you EVER been a member of, assisted in, or participated in any group, unit, or organization of any kind
in which you or other persons used any type of weapon against any person or threatened to do so?
Yes
No
14. Have you EVER assisted or participated in selling or providing weapons to any person who to your
knowledge used them against another person, or in transporting weapons to any person who to your
knowledge used them against another person?
Yes
No
15. Have you EVER received any type of military, paramilitary, or weapons training?
Yes
No
16. Are you under a final order or civil penalty for violating section 274C (producing and/or using false
documentation to unlawfully satisfy a requirement of the Immigration and Nationality Act)?
Yes
No
17. Have you EVER, by fraud or willful misrepresentation of a material fact, sought to procure, or procured, a
visa or other documentation, for entry into the United States or any immigration benefit?
Yes
No
18. Have you EVER left the United States to avoid being drafted into the U.S. Armed Forces?
Yes
No
19. Have you EVER been a J nonimmigrant exchange visitor who was subject to the two-year foreign residence
requirement and not yet complied with that requirement or obtained a waiver of such?
Yes
No
20. Have you EVER detained, retained, or withheld the custody of a child, having a lawful claim to U.S.
citizenship, outside the United States from a U.S. citizen granted custody?
Yes
No
21. Do you plan to practice polygamy in the United States?
Yes
No
22. Have you entered the United States as a stowaway?
Yes
No
23. a. Do you have a communicable disease of public health significance?
Yes
No
b. Do you have or have you had a physical or mental disorder and behavior (or a history of behavior that is
likely to recur) associated with the disorder which has posed or may pose a threat to the property, safety,
or welfare of yourself or others?
Yes
No
c. Are you now or have you been a drug abuser or drug addict?
Form I-914 (Rev. 02/01/11) Y Page 6
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