Official Federal Forms > US Citizenship And Immigration Services
Application For T Nonimmigrant Status I-914 - Official Federal Forms
| Application For T Nonimmigrant Status Form. This is a national form and can be used in US Citizenship And Immigration Services . |
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Department of Homeland Security U.S. Citizenship and Immigration Services OMB No. 1615-0099; Expires 05/31/2014 I-914, Application for T Nonimmigrant Status For USCIS Use Only Returned Date Date Resubmitted Date Date Reloc Sent Date Date Reloc Rec'd Date Receipt START HERE - Type or print. Use black ink. See Instructions for information about eligibility and how to complete and file this application. PART A. Purpose for Filing the Application Check all that apply: I am filing an application for T-1 nonimmigrant status, and have not previously filed for such status. I have a T-1 application pending. EAC #: I have received T-1 status. I am applying to bring family member(s) to the United States. PART B. General Information About You (Person filing this form as a victim) Family Name (Last Name) Given Name (First Name) Middle Name (if any) Other Names Used (Include maiden name/nickname) Home Address - Street Number and Name City State/Province Apt. # Zip/Postal Code Date Validity Dates From: To: Safe Mailing Address (if other than above) - Street Number and Name C/O (in care of): City Home Telephone # (with area code) State/Province Safe Daytime Phone # (with area code) Apt. # Remarks Zip/Postal Code E-Mail Address (optional) Conditional Approval Stamp # Date A # (if any) U.S. Social Security # (if any) Gender Male Action Block Female Widowed Marital Status: Married Single/Never Married Divorced Date of Birth (mm/dd/yyyy) Country of Birth Country of Citizenship Passport # Place of Last Entry Place of Issuance Date of Issue (mm/dd/yyyy) To Be Completed by Attorney or Representative, if any Date of Last Entry (mm/dd/yyyy) Current Immigration Status Fill in box if G-28 is attached to represent the applicant. ATTY State License # Form I-914 (05/04/12) Y I-94 # (Arrival/Departure Document) American LegalNet, Inc. www.FormsWorkFlow.com PART C. Additional Information Answers to the following questions about your claim require explanation and supporting documentation. You should attach documents in support of your claim that you are a victim of a severe form of trafficking in persons and the specific facts on which you are relying to support your claim. It is strongly encouraged that you attach a personal narrative statement describing the trafficking. If you are only applying for T derivative status for a family member subsequent to your (the principal applicant) initial filing, evidence supporting the original application is not required to be resubmitted with the new Form I-914. Attach additional sheets of paper as needed. Write your name and Alien Registration Number (A-Number), if any, at the top of each sheet and indicate the number of the item that you are answering. Include the Part and letter or number relating to the additional information you provided (example: Part C, 3). 1. I am or have been a victim of a severe form of trafficking in persons. (Attach evidence to support your claim.) 2. I am submitting a law enforcement agency (LEA) declaration on Form I-914, Supplement B, Declaration of Law Enforcement Officer for Victim of Trafficking in Persons. (If "No," explain why you are not submitting the LEA Certification.) 3. I am physically present in the United States, American Samoa, or the Commonwealth of the Northern Mariana Islands, or at a port of entry, on account of trafficking. (If "Yes," explain in detail and attach evidence and documents supporting this claim.) 4. I fear that I will suffer extreme hardship involving unusual and severe harm upon removal. (If "Yes," explain in detail and attach evidence and documents supporting this claim.) 5. I have reported the crime of which I am claiming to be a victim. (If "Yes," indicate to which law enforcement agency and office you have made the report, the address and phone number of that office, and the case number assigned, if any. If "No," explain the circumstances.) Law Enforcement Agency and Office Address Phone Number Yes Yes No No Yes No Yes No Yes No Case Number Circumstances: 6. I am under the age of 18 years. (If "Yes," proceed to Question 8.) 7. I have complied with requests from Federal, State, or local law enforcement authorities for assistance in the investigation or prosecution of acts of trafficking. (If "No," explain the circumstances.) 8. This is the first time I have entered the United States. (If "No," list each date, place of entry, and under which status you entered the United States for the past five years, and explain the circumstances of your most recent arrival.) Date of Entry Place of Entry Status Yes Yes No No Yes No Form I-914 (05/04/12) Y Page 2 American LegalNet, Inc. www.FormsWorkFlow.com PART C. Additional Information (Continued) Yes No 9. My most recent entry was on account of the trafficking that forms the basis for my claim. (Explain the circumstances of your most recent arrival.) 10. I want an Employment Authorization Document. 11. I am now applying for one or more eligible family members. (If "Yes," complete and include a Form I-914, Supplement A, Application for Immediate Family Member of T-1 Recipient, for each family member for whom you are now applying. You may also apply to bring eligible family members to the United States at a later date.) Yes Yes No No PART D. Processing Information Answer the following questions about yourself. For purposes of this application, if applicable, you must answer "Yes" to the following questions, even if your records were sealed or otherwise cleared or if anyone, including a judge, law enforcement officer, or attorney, told you that you no longer have a record. (If your answer is "Yes" to any one of these questions, explain on a separate sheet of paper. Additionally, explain if any of the acts or circumstances below are related to you having been a victim of a severe form of trafficking. Answering "Yes" does not necessarily mean that you will be denied T nonimmigrant status or are not entitled to adjust your status or register for permanent residence.) 1. Have you EVER: a. Committed a crime or offense for which you have not been arrested? b. Been arrested, cited, or detained by any law enforcement officer (including DHS, former INS, and military officers) for any reason? c. Been charged with committing any crime or offense? d. Been convicted of a crime or offense (even if violation was subsequently expunged or pardoned)? e. Been placed in an alternative sentencing or a rehabilitative program (for example: diversion, deferred prosecution, withheld adjudica
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