Form I-918 - Petition For U Nonimmigrant Status Page 2
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8Part 2. Additional information.
Answers to the questions below require explanations and supporting documentation. Attach relevant documents in support of your
claims that you are a victim of criminal activity listed in the Immigration and Nationality Act (INA), section 101(a)(15)(U). You must
also attach a personal narrative statement describing the criminal activity of which you were the victim. If you are only petitioning for
U derivative status for a qualifying family member(s) subsequent to your (the principal petitioner) initial filing, evidence supporting
the original petition is not required to be submitted with the new Form I-918.
Attach additional sheets of paper as needed. Write your name and Alien Registration Number (A #), if any, at the top of each sheet
and indicate the number of the item that refers to your answer. Include the Part and letter or number relating to the additional
information you provided (example: Part 2, Z).
Check either "Yes" or "No" as appropriate to each of the following questions.
Yes
No
1. I am a victim of criminal activity listed in the INA at section 101(a)(15)(U).
Yes
No
2. I have suffered substantial physical or mental abuse as a result of having been a victim of this
criminal activity.
3. I possess information concerning the criminal activity of which I was a victim.
Yes
No
4. I am submitting a certification from a certifying official on Form I-918 Supplement
Yes
No
B, U Nonimmigrant Status Certification.
5. The crime of which I am a victim occurred in the United States including Indian
Yes
No
country and military installations) or violated the laws of the United States.
6. I am under the age of 16 years.
Yes
No
7. I want an Employment Authorization Document.
Yes
No
Yes
No
8. Have you ever been in immigration proceedings?
If "Yes," what type of proceedings? (Check all that apply.)
Removal Date
Exclusion Date
Deportation Date
Recission Date
Judicial Date
(mm/dd/yyyy)
(mm/dd/yyyy)
(mm/dd/yyyy)
(mm/dd/yyyy)
(mm/dd/yyyy)
9. List each date, place of entry and status under which you entered the United States during the five years preceding the filing of
this petition.
Date of Entry (mm/dd/yyyy)
Place of Entry
Status at Entry
Form I-918 (Rev. 11/23/10) Y Page 2
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