Form I-800 - Petition To Classify Convention Adoptee As An Immediate Relative
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9Form I-800, Petition to Classify Convention
Department of Homeland Security
Adoptee as an Immediate Relative
U.S. Citizenship and Immigration Services
START HERE - Type or Print (Use black ink)
For Official Use Only
Part 1.
Information About You (Person filing this petition)
Returned
Receipt
NOTICE
Date
You may not submit Form I-800 if there have been certain changes in your circumstances
Date
since your last home study was completed and your Form I-800A, Application for
Resubmitted
Determination of Suitability to Adopt a Child from a Convention Country, was last
approved or extended. If there has been a change, STOP. See instructions for Form I-800
Date
for more information on the type of changes requiring the filing of a new Form I-800A or
Date
Form I-800A, Supplement 3.
Reloc Sent
NOTE: If you need more space to complete an answer, use a separate sheet of paper.
Date
Write your name, your USCIS Account Number, and the child's current legal name at the
top of each sheet of paper and indicate the part and number of the item to which the
Date
answer refers.
Reloc Rec'd
1. Provide the following information about yourself:
Date
Family Name (Last Name)
Given Name (First Name)
Middle Name
Date
1. The petition is provisionally approved
for a Convention Adoptee who will be:
Other Names Used (including maiden name if appropriate)
Adopted
Coming to the U.S. for
abroad.
adoption. Preadoption
requirements met.
USCIS Account #
U.S. Social Security # (if any)
2. The child will seek:
IV.
NIV, so as to apply for
naturalization under Sec. 322
Date of Birth (mm/dd/yyyy)
Place of Birth (City/Town, State/Province, Country)
after lawful admission.
Adjustment of Status under Sec. 245.
3. The petitioner is:
Home Address - Street Number and Name
Apt. #
Married
Unmarried
Provisional Action Block:
City
State or Province
Zip/Postal Code
Country
Mailing Address (if different from home address)
Apt. #
C/O (in care of)
City
State or Province
Final Action Block:
Child's legal name after adoption:
Zip/Postal Code
Country
Contact Information:
Daytime Phone #
E-Mail Address
(with area/country code)
(if any)
Officer Signature
Date
2. Is the daytime phone number the same as the one provided on
Yes
No
To Be Completed By
Form I-800A?
Attorney or Representative, if any.
Check if G-28 is attached.
3. Is the e-mail address (if any) the same as the one provided on
Yes
No
ATTY State License #
Form I-800A?
Form I-800 11/23/10 Y
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