Immigration Processes

SPECIAL REGISTRATION APPLICANT QUESTIONNAIRE

1. My name is:______________________________________________
                           Family/Last Name    First Name    Middle Name

2. My present address is:
Number and Street and Apt. No.:________________
City:____________________ State/Province:___________
Zip/Postal Code:_________ Country:_________________

3. My phone/fax numbers are (and I have checked the box next to the number at which I prefer to be contacted):

• Home:_____________________________
• Work:_____________________________
• Cell:_____________________________
• Fax:_____________________________

4. My e-mail address(es) is (are):
_____________________________________________________

5. I ___prefer ___do not prefer to be contacted by e-mail.

6. My place of birth is:

City:_________________ State/Province:___________ Country:______________

7. My date of birth is (month/day/year):________________

8. My country of citizenship is:_______________________

9. I am ___Male ___Female.

10. I am ___Married ___Single (never married) ___Divorced ___Widowed.

11. Other names, including maiden name, that I have used are (attach evidence of legal name change):

_____________________________________________________________

12. Date (month/day/year) and place (city/state/country) of my present marriage (if married):

_____________________________________________________________

13. My social security number is (if none, so state):_______________________

14. My Alien Registration Number is (if none, so state):_______________________

15. My passport information is:
Number:___________________________________
Issuance date (month/day/year):___________________
Expiry date (month/day/year):______________________
Country of issuance:______________________________

16. In the last ten (10) years, I have entered the following countries:
Country:__________________________ Year(s) of visit:__________________________
Country:__________________________ Year(s) of visit:__________________________
Country:__________________________ Year(s) of visit:__________________________
Country:__________________________ Year(s) of visit:__________________________
Country:__________________________ Year(s) of visit:__________________________
Country:__________________________ Year(s) of visit:__________________________
Country:__________________________ Year(s) of visit:__________________________
Country:__________________________ Year(s) of visit:__________________________
Country:__________________________ Year(s) of visit:__________________________
Country:__________________________ Year(s) of visit:__________________________

17. The following countries have issued me a passport
Country of issuance:__________________________
Passport Number:__________________________
Issuance date (month/day/year):__________________________
Expiry date (month/day/year):__________________________

Country of issuance:__________________________
Passport Number:__________________________
Issuance date (month/day/year):__________________________
Expiry date (month/day/year):__________________________

18. I have lost a passport before or had a passport stolen before:
_____No
_____Yes –
(a) Date of loss (month/day/year):____________________________
Place of loss (city, country):____________________________
Manner of loss (explain):____________________________

(b) Date of loss (month/day/year):____________________________
Place of loss (city, country):____________________________
Manner of loss (explain):____________________________

19. I have been issued a U.S. visa before:
_____No
_____Yes –
(a) Type of visa:____________________________
Issuance date (month/date/year):____________________________
Place of issue (city, country):____________________________

(b) Type of visa:____________________________
Issuance date (month/date/year):____________________________
Place of issue (city, country):____________________________

(c) Type of visa:____________________________
Issuance date (month/date/year):____________________________
Place of issue (city, country):____________________________

(d) Type of visa:____________________________
Issuance date (month/date/year):____________________________
Place of issue (city, country):____________________________

(e) Type of visa:____________________________
Issuance date (month/date/year):____________________________
Place of issue (city, country):____________________________

20. I have been refused a U.S. visa before:
_____No
_____Yes –
(a) Type of visa:____________________________
Refusal date (month/date/year):____________________________
Place of refusal (city, country):____________________________

(b) Type of visa:____________________________
Refusal date (month/date/year):____________________________
Place of refusal (city, country):____________________________

(c) Type of visa:____________________________
Refusal date (month/date/year):____________________________
Place of refusal (city, country):____________________________

(d) Type of visa:____________________________
Refusal date (month/date/year):____________________________
Place of refusal (city, country):____________________________

(e) Type of visa:____________________________
Refusal date (month/date/year):____________________________
Place of refusal (city, country):____________________________

21. My U.S. visa has been cancelled or revoked before:
_____No
_____Yes –
(a) Type of visa:____________________________
Cancellation/revocation date (month/date/year):____________________________
Place of cancellation/revocation (city, country):____________________________

(b) Type of visa:____________________________
Cancellation/revocation date (month/date/year):____________________________
Place of cancellation/revocation (city, country):____________________________

(c) Type of visa:____________________________
Cancellation/revocation date (month/date/year):____________________________
Place of cancellation/revocation (city, country):____________________________

(d) Type of visa:____________________________
Cancellation/revocation date (month/date/year):____________________________
Place of cancellation/revocation (city, country):____________________________

(e) Type of visa:____________________________
Cancellation/revocation date (month/date/year):____________________________
Place of cancellation/revocation (city, country):____________________________

22. An immigrant visa petition has been filed on my behalf:
_____No
_____Yes –
Type of petition:____________________________
Name of Petitioner:____________________________
Relationship of Petitioner to me:____________________________
Petitioner’s address (No. and Street and Apt. No.):____________________________
___________________________________________________________________________
City:____________________________ State/Province:____________________________
Zip/Postal Code:____________________________ Country:____________________________
Date petition was filed (month/day/year):____________________________
CIS office where application was filed (city, state):____________________________
Receipt number (if available):____________________________
The petition is/was:
_____Pending
_____Denied on (Month/Day/Year)_________________________________
_____Approved on (Month/Day/Year)_________________________________
_____Abandoned on (Month/Day/Year)_________________________________
_____Other:____________________________________________________________

23. The following persons are in the U.S., or they have U.S. legal permanent residence or U.S. citizenship. [Mark YES or NO and indicate that person’s status in the U.S. (i.e., U.S. legal permanent resident, U.S. citizen, F-1 student, H-1B worker, B-2 visitor, etc.).]
_____No _____Yes Husband/Wife ________________________
_____No _____Yes Father/Mother ________________________
_____No _____Yes Fiancé/Fiancée ________________________
_____No _____Yes Son/Daughter ________________________
_____No _____Yes Brother/Sister ________________________

24. My immigration status in the U.S. is:
_____I am in nonimmigrant visa status in the U.S. – information about my last entry into the U.S.:
Visa category used at entry:______________ Current visa status:________________
Form I-94/I-95 Number:________________________
Date of last arrival (month/day/year):________________________
Place of last arrival (city/state):________________________
My authorized stay, as shown on Form I-94/I-95, expires/expired on:________________________
I _____was _____was not inspected/interviewed by a U.S. Immigration Officer.
Nonimmigrant visa number:________________________
Consulate where visa was issued:________________________
Date visa was issued (month/day/year):________________________

_____I am a lawful permanent resident of the U.S. – information about my LPR status:
Resident since (month/day/year):_____________________________
Permanent Resident Card expires on (month/day/year):_____________________________
Category (e.g., IR6, CR6, E16, E36, etc.):_____________________________

Consulate where Immigrant Visa was issued or CIS office where status was Adjusted (city, state/country)_____________________________

Since I was granted permanent residence, I have filed Form I-407, Abandonment by Alien of Status as Lawful Permanent Resident or otherwise been judged to have abandoned my status: _____No _____Yes

I have applied for asylum in the U.S. – information about my asylum application:
Asylum application filed on (month/day/year):_____________________________
CIS office where application was filed (city, state):_____________________________
Date application was filed (month/day/year):_____________________________
Receipt number (if available):_____________________________
I was interviewed on (month/day/year)__________________ in (city, state)_________________
The application is/was:
_____Pending
_____Denied on (Month/Day/Year)_________________________________________
_____Approved on (Month/Day/Year)_________________________________________
_____Abandoned on (Month/Day/Year)_________________________________________
_____Other:________________________________________________________________

25. I have been under immigration proceedings:
_____No
_____Yes, at __________________________________ on _______________
                                                 City and State                                  (Month/Day/Year)
and it was for this type of proceeding:
_____Exclusion
_____Deportation
_____Rescission
_____Judicial proceedings

26. I have previously applied for permanent resident status in the U.S.:
_____No
_____Yes, at __________________________________ on _______________
                                                 City and State                                  (Month/Day/Year)
and it was for this type of proceeding:
and the application is/was:
_____Pending
_____Denied on (Month/Day/Year)___________________________________
_____Approved on (Month/Day/Year)___________________________________
_____Abandoned on (Month/Day/Year)___________________________________
_____Other:_______________________________________________________________________

27. Information about my current spouse and all my children (including children born of prior marriages or relationships or who are now deceased):
(a) Full name (maiden last name/first/middle):
Relationship:Husband / Wife____________ Date of birth (month/day/year):______________________
Country of birth:___________________ Alien registration number:__________________________
Address Number and Street and Apt. No.:________________________________________
City:_____________________________________ State/Province:_______________________
Zip/Postal Code:_______________ Country:___________________________________
Telephone No.:_________________ Date (month/day/year) of marriage:__________________
Place (city/state/country) of marriage:_________________________

(b) Full name (last/first/middle):____________________________________
Relationship:____________________ Date of birth (month/day/year):________________________
Country of birth:___________________ Alien registration number:__________________________
Address Number and Street and Apt. No.:________________________________________
City:_____________________________________ State/Province:_______________________
Zip/Postal Code:_______________ Country:___________________________________
Telephone No.:_________________

(c) Full name (last/first/middle):____________________________________
Relationship:____________________ Date of birth (month/day/year):________________________
Country of birth:___________________ Alien registration number:__________________________
Address Number and Street and Apt. No.:________________________________________
City:_____________________________________ State/Province:_______________________
Zip/Postal Code:_______________ Country:___________________________________
Telephone No.:_________________

(d) Full name (last/first/middle):____________________________________
Relationship:____________________ Date of birth (month/day/year):________________________
Country of birth:___________________ Alien registration number:__________________________
Address Number and Street and Apt. No.:________________________________________
City:_____________________________________ State/Province:_______________________
Zip/Postal Code:_______________ Country:___________________________________
Telephone No.:_________________

(e) Full name (last/first/middle):____________________________________
Relationship:____________________ Date of birth (month/day/year):________________________
Country of birth:___________________ Alien registration number:__________________________
Address Number and Street and Apt. No.:________________________________________
City:_____________________________________ State/Province:_______________________
Zip/Postal Code:_______________ Country:___________________________________
Telephone No.:_________________

28. My last address abroad was:
Number and Street and Apt. No.:______________________________________________
City:____________________________ State/Province:__________________________
Postal Code:________________________ Country:____________________________
Telephone No.:_________________________________

29. The last address at which I lived together with my current spouse was/is:
Number and Street and Apt. No.:______________________________________________
City:____________________________ State/Province:__________________________
Postal Code:________________________ Country:____________________________
Telephone No.:_________________________________

30. Information about my father:
Name:______________________________________________
                Family/Last Name     First Name     Middle Name
Date of birth (month/day/year):______________________________
City and country of birth:____________________________________________
Address Number and Street and Apt. No.:________________________________________
City:_______________________________ State/Province:______________________________
Zip/Postal Code:____________________ Country:_________________________
Telephone No.:____________________________________________

31. Information about my mother:
Name:______________________________________________
                Maiden Family/Last Name     First Name     Middle Name
Date of birth (month/day/year):______________________________
City and country of birth:____________________________________________
Address Number and Street and Apt. No.:________________________________________
City:_______________________________ State/Province:______________________________
Zip/Postal Code:____________________ Country:_________________________
Telephone No.:____________________________________________

32. Information about my former husbands/wives:
Name:________________________________________________________________
                Family/Last Name (for former wife, give maiden name)     First Name     Middle Name
Date of birth (month/day/year):______________________________
City and country of birth:____________________________________________
City and country of present residence (if deceased, so indicate):_____________________________
Address Number and Street and Apt. No.:________________________________________
City:_______________________________ State/Province:______________________________
Zip/Postal Code:____________________ Country:_________________________
Telephone No.:____________________________________________
Date (month/day/year) of marriage:______________________________________
Place (city/state/country) of marriage:______________________________________
Date (month/day/year) of termination of marriage:______________________________________
Place (city/state/country) of termination of marriage:______________________________________

(b) Name:________________________________________________________________
                Family/Last Name (for former wife, give maiden name)     First Name     Middle Name
Date of birth (month/day/year):______________________________
City and country of birth:____________________________________________
City and country of present residence (if deceased, so indicate):_____________________________
Address Number and Street and Apt. No.:________________________________________
City:_______________________________ State/Province:______________________________
Zip/Postal Code:____________________ Country:_________________________
Telephone No.:____________________________________________
Date (month/day/year) of marriage:______________________________________
Place (city/state/country) of marriage:______________________________________
Date (month/day/year) of termination of marriage:______________________________________
Place (city/state/country) of termination of marriage:______________________________________

33. Information about my brothers and sisters:
(a) Full name (maiden last name/first/middle):____________________________________________
Relationship:___________________ Date of birth (month/day/year):______________________________
Country of birth:__________________________ Alien registration number:______________________
Address Number and Street and Apt. No.:________________________________________
City:_______________________________ State/Province:______________________________
Zip/Postal Code:____________________ Country:_________________________
Telephone No.:____________________________________________

(b) Full name (maiden last name/first/middle):____________________________________________
Relationship:___________________ Date of birth (month/day/year):______________________________
Country of birth:__________________________ Alien registration number:______________________
Address Number and Street and Apt. No.:________________________________________
City:_______________________________ State/Province:______________________________
Zip/Postal Code:____________________ Country:_________________________
Telephone No.:____________________________________________

(c) Full name (maiden last name/first/middle):____________________________________________
Relationship:___________________ Date of birth (month/day/year):______________________________
Country of birth:__________________________ Alien registration number:______________________
Address Number and Street and Apt. No.:________________________________________
City:_______________________________ State/Province:______________________________
Zip/Postal Code:____________________ Country:_________________________
Telephone No.:____________________________________________

(d) Full name (maiden last name/first/middle):____________________________________________
Relationship:___________________ Date of birth (month/day/year):______________________________
Country of birth:__________________________ Alien registration number:______________________
Address Number and Street and Apt. No.:________________________________________
City:_______________________________ State/Province:______________________________
Zip/Postal Code:____________________ Country:_________________________
Telephone No.:____________________________________________

(e) Full name (maiden last name/first/middle):____________________________________________
Relationship:___________________ Date of birth (month/day/year):______________________________
Country of birth:__________________________ Alien registration number:______________________
Address Number and Street and Apt. No.:________________________________________
City:_______________________________ State/Province:______________________________
Zip/Postal Code:____________________ Country:_________________________
Telephone No.:____________________________________________

34. Two contacts (not including my immediate family members or other relatives) in my native country who can verify information about me:

(a) Full name (maiden last name/first/middle):____________________________________________
Address Number and Street and Apt. No.:________________________________________
City:_______________________________ State/Province:______________________________
Zip/Postal Code:____________________ Country:_________________________
Telephone No.:____________________________________________

(b) Full name (maiden last name/first/middle):____________________________________________
Address Number and Street and Apt. No.:________________________________________
City:_______________________________ State/Province:______________________________
Zip/Postal Code:____________________ Country:_________________________
Telephone No.:____________________________________________

35. Information about my residences for the last ten years, starting with my present address:

(a) Number and Street and Apt. No.:________________________________________
City:_______________________________ State/Province:______________________________
Country:__________________ From (Month/Year):_____________ To (Month/Year):_____________ PRESENT _______
Telephone No.:____________________________________________

(b) Number and Street and Apt. No.:________________________________________
City:_______________________________ State/Province:______________________________
Country:__________________ From (Month/Year):_____________ To (Month/Year):_____________ PRESENT _______
Telephone No.:____________________________________________

(c) Number and Street and Apt. No.:________________________________________
City:_______________________________ State/Province:______________________________
Country:__________________ From (Month/Year):_____________ To (Month/Year):_____________ PRESENT _______
Telephone No.:____________________________________________

(d) Number and Street and Apt. No.:________________________________________
City:_______________________________ State/Province:______________________________
Country:__________________ From (Month/Year):_____________ To (Month/Year):_____________ PRESENT _______
Telephone No.:____________________________________________

(e) Number and Street and Apt. No.:________________________________________
City:_______________________________ State/Province:______________________________
Country:__________________ From (Month/Year):_____________ To (Month/Year):_____________ PRESENT _______
Telephone No.:____________________________________________

(f) Number and Street and Apt. No.:________________________________________
City:_______________________________ State/Province:______________________________
Country:__________________ From (Month/Year):_____________ To (Month/Year):_____________ PRESENT _______
Telephone No.:____________________________________________

(g) Number and Street and Apt. No.:________________________________________
City:_______________________________ State/Province:______________________________
Country:__________________ From (Month/Year):_____________ To (Month/Year):_____________ PRESENT _______
Telephone No.:____________________________________________

(h) Number and Street and Apt. No.:________________________________________
City:_______________________________ State/Province:______________________________
Country:__________________ From (Month/Year):_____________ To (Month/Year):_____________ PRESENT _______
Telephone No.:____________________________________________

(i) Number and Street and Apt. No.:________________________________________
City:_______________________________ State/Province:______________________________
Country:__________________ From (Month/Year):_____________ To (Month/Year):_____________ PRESENT _______
Telephone No.:____________________________________________

(j) Number and Street and Apt. No.:________________________________________
City:_______________________________ State/Province:______________________________
Country:__________________ From (Month/Year):_____________ To (Month/Year):_____________ PRESENT _______
Telephone No.:____________________________________________

36. Information about my last address outside the United States of more than one year:

Number and Street and Apt. No.:_________________________________________

City:_____________________ State/Province:_________________________________________

Country:_____________________ From (Month/Year):_______________ To(Month/Year):_______________

Telephone No.:_______________________________________

37. Information about all educational institutions I attended or have attended, including vocational institutions but not elementary schools:
(a) School Name:_________________________________________
Number and Street and Apt. No.:_________________________________________
City:____________________________ State/Province:____________________________
Country:_________________________ Course of Study:_______________________________
Telephone No.:____________________ From (Month/Year):_______________ To(Month/Year):_______________

(b) School Name:_________________________________________
Number and Street and Apt. No.:_________________________________________
City:____________________________ State/Province:____________________________
Country:_________________________ Course of Study:_______________________________
Telephone No.:____________________ From (Month/Year):_______________ To(Month/Year):_______________

(c) School Name:_________________________________________
Number and Street and Apt. No.:_________________________________________
City:____________________________ State/Province:____________________________
Country:_________________________ Course of Study:_______________________________
Telephone No.:____________________ From (Month/Year):_______________ To(Month/Year):_______________

(d) School Name:_________________________________________
Number and Street and Apt. No.:_________________________________________
City:____________________________ State/Province:____________________________
Country:_________________________ Course of Study:_______________________________
Telephone No.:____________________ From (Month/Year):_______________ To(Month/Year):_______________

(e) School Name:_________________________________________
Number and Street and Apt. No.:_________________________________________
City:____________________________ State/Province:____________________________
Country:_________________________ Course of Study:_______________________________
Telephone No.:____________________ From (Month/Year):_______________ To(Month/Year):_______________

38. Information about my employment history for the last four employers, starting with my present employer (if none, so state):
(a) Employer Name:_________________________ Job Title:____________________________
Number and Street and Apt. No.:_________________________________________
City:____________________________ State/Province:____________________________
Country:_________________________ From (Month/Year):_____________ To (Month/Year):_____________ PRESENT _______
Telephone No.:__________________________
Description of my job duties:

(b) Employer Name:_________________________ Job Title:____________________________
Number and Street and Apt. No.:_________________________________________
City:____________________________ State/Province:____________________________
Country:_________________________ From (Month/Year):_____________ To (Month/Year):_____________ PRESENT _______
Telephone No.:__________________________
Description of my job duties:

(c) Employer Name:_________________________ Job Title:____________________________
Number and Street and Apt. No.:_________________________________________
City:____________________________ State/Province:____________________________
Country:_________________________ From (Month/Year):_____________ To (Month/Year):_____________ PRESENT _______
Telephone No.:__________________________
Description of my job duties:

(d) Employer Name:_________________________ Job Title:____________________________
Number and Street and Apt. No.:_________________________________________
City:____________________________ State/Province:____________________________
Country:_________________________ From (Month/Year):_____________ To (Month/Year):_____________ PRESENT _______
Telephone No.:__________________________
Description of my job duties:

39. My present and past membership in or affiliation with every political, professional, social and charitable organizations, associations, funds, foundations, parties, clubs, societies, or similar groups in the United States or in other places since my 16th birthday (if none, so state):

Name of organization     Location (city/state)     Dates of membership     Nature of organization

40. Please answer the following questions. (If your answer is “Yes” on any one of these questions, explain on a separate piece of paper. Answering “Yes” does not necessarily mean that you are not entitled to register for permanent residence or adjust status.)

(1) Have you ever, in or outside the U.S.:
a. knowingly committed any crime of moral turpitude or a drug related offense for which you have not been arrested? _____Yes _____No
b. been arrested, cited, charged, indicted, fined, or imprisoned for breaking or violating any law or ordinance, excluding minor traffic violations? _____Yes _____No
c. been the beneficiary of a pardon, amnesty, rehabilitation decree, other act of clemency or similar action? _____Yes _____No
d. exercised diplomatic immunity to avoid prosecution for a criminal offense in the U.S.? _____Yes _____No

(2) Have you received public assistance in the U.S. from any source, including the U.S. government or any state, county, city, or municipality (other than emergency medical treatment), or are you likely to receive public assistance in the future? _____Yes _____No

(3) Have you ever:
a. within the past 10 years been a prostitute or procured anyone for prostitution, or intend to engage in such activities in the future? _____Yes _____No
b. engaged in any unlawful commercialized vice, including, but not limited to, illegal gambling? _____Yes _____No
c. knowingly encouraged, induced, assisted, abetted or aided any alien to try to enter the U.S. illegally? _____Yes _____No
d. illicitly trafficked in any controlled substance, or knowingly assisted, abetted or colluded in the illicit trafficking of any controlled substance? _____Yes _____No

(4) Have you ever engaged in, conspired to engage in, or do you intend to engage in, or have you ever solicited membership or funds for, or have you through any means ever assisted or provided any type of material support to, any person or organization that has ever engaged or conspired to engage, in sabotage, kidnapping, political assassination, hijacking, or any other form of terrorist activity? _____Yes _____No

(5) Do you intend to engage in the U.S. in:
a. espionage? _____Yes _____No
b. any activity a purpose of which is opposition to, or the control or overthrow of, the Government of the United States, by force, violence or other unlawful means? _____Yes _____No
c. any activity to violate or evade any law prohibiting the export from the United States of goods, technology or sensitive information? _____Yes _____No

(6) Have you ever been a member of, or in any way affiliated with, the Communist Party or any other totalitarian party? _____Yes _____No

(7) Did you, during the period March 23, 1933 to May 8, 1945, in association with either the Nazi Government of Germany or any organization or government associated or allied with the Nazi Government of Germany, ever order, incite, assist or otherwise participate in the persecution of any person because of race, religion, national origin or political opinion? _____Yes _____No

(8) Have you ever engaged in genocide, or otherwise ordered, incited, assisted or otherwise participated in the killing of any person because of race, religion, nationality, ethnic origin, or political opinion? _____Yes _____No

(9) Have you ever been deported from the U.S., or removed from the U.S. at government expense, excluded within the past year, or are you now in exclusion or deportation proceedings? _____Yes _____No

(10) Are you under a final order of civil penalty for violating section 274C of the Immigration Act for use of fraudulent documents or have you, by fraud or willful misrepresentation of a material fact, ever sought to procure, or procured, a visa, other documentation, entry into the U.S., or any other immigration benefit? _____Yes _____No

(11) Have you ever left the U.S. to avoid being drafted into the U.S. Armed Forces? _____Yes _____No

(12) 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? _____Yes _____No

(13) Are you now withholding custody of a U.S. citizen child outside the U.S. from a person granted custody of the child? _____Yes _____No

(14) Do you plan to practice polygamy in the U.S.? _____Yes _____No

(15) Have you attended a U.S. public elementary school on student (F) status or a public secondary school after November 30, 1996 without reimbursing the school? _____Yes _____No

(16) Have you ever been refused admission to the U.S., or been the subject of a deportation hearing, or sought to obtain or assist others to obtain a visa, entry into the U.S., or any other U.S. immigration benefit by fraud or willful misrepresentation or other unlawful means? _____Yes _____No

(17) Have you ever violated the terms of a U.S. visa, or been unlawfully present in, or deported from, the United States? _____Yes _____No

(18) Have you ever voted in the United States in violation of any law or regulation? _____Yes _____No

(19) Have you ever renounced U.S. citizenship for the purpose of avoiding taxation? _____Yes _____No

(20) Have you ever been afflicted with a communicable disease of public health significance or a dangerous physical or mental disorder, or ever been a drug abuser or addict? _____Yes _____No

(21) Do you have any specialized skills or training, including firearms, explosives, nuclear, biological, or chemical experience? _____Yes _____No

(22) Have you ever performed military service? _____Yes _____No

If YES, give name of country, branch of service, rank/position, military specialty, and dates of service:

(23) Have you ever been in an armed conflict, either as a participant or victim? _____Yes _____No

If you would like further information about specific case scenarios or situations, please call our office or email us at ckuck@immigration.net to speak to one of experienced immigration attorneys.