U Nonimmigrant Status Questionnaire Principal Applicant

Transcription

1 U Nonimmigrant Status Questionnaire Principal Applicant Please complete this questionnaire as well as you can. If a question doesn t apply to you, please write N/A. If you need more space, finish your answer on an additional page. Biographical Information About You. Last First Middle Name: Name: Name: Other Names Used (including maiden name): Home Address: City: Zip Code: Safe Address: City Zip Care of: Home telephone Safe Telephone (if any) A-number (if any) Social Security Number (if any) Gender: X M F Marital Status: Married X Single Divorced Widowed Date of Birth: Month Day Year Country of Citizenship: Country of Birth: Passport Number: Place of Issuance: Date of Issuance: Place of last entry to US California Date of last entry to US: 07/02/1990 I-94 Number (if any) Current Immigration Status: (e.g. tourist, student, or none) If you know you qualify for U Nonimmigrant Status, you should answer questions 1-5 and question 7 YES. Yes No 1. I am applying for U nonimmigrant status because I was a crime victim. X 2. I have suffered abuse as a result of the crime. X 3. I have information about the crime. X 4. I am submitting a certification from law enforcement. X 5. The crime was in the U.S. X 6. I am under age I want an Employment Authorization Document. (mark yes) X 8. Have you ever been in Immigration Proceedings? Yes No If yes, what type? Mark all that apply and write the date. Removal Date Exclusion Date Deportation Date Rescission Date Immigration Court Date 9. Each date, place and immigration status of each entry to the U.S. within the past 5 years. Entry Date Place of Entry Status when you entered Have you ever: Yes No 1

2 a. Committed a crime or offense for which you have not been arrested? X b. Been arrested, cited or detained by any law enforcement officer (including DHS, X former INS and military officers) for any reason? c. Been charged (by a Prosecuting Attorney) with committing any crime or offense? X d. Been convicted of a crime or offense (even if it was expunged, erased or pardoned)? X e. Been given an alternative sentence (for example: diversion) X f. Received a suspended sentence, been placed on probation or been paroled? X g. Been in jail or prison? X h. Gotten a pardon, amnesty, rehabilitation, or other act of clemency to forgive a conviction? X i. Exercised diplomatic immunity to avoid prosecution for a criminal offense in the United States? X If you answered any of the above questions yes, complete this table in your own words. Why were you arrested, cited detained or charged? Date of arrest, detention, charges (mm/dd/yyyy) Where were you arrested, detained or charged? (City, State, Country) Outcome or disposition Have you ever received government support like welfare or medical care? X Yes No QUESTIONS ABOUT MORAL ISSUES Yes No a Have you ever worked as a prostitute or hired a prostitute? X b. Have you ever gambled illegally? X c. Have you ever helped someone enter the U.S. Illegally? X d. Have you ever sold drugs or helped someone else sell drugs? X It important to the U.S. government to protect people from terrorism and oppression. Questions 4 through 13 ask a lot of questions that try to get at whether you might be a terrorist or someone who has persecuted people. There are questions about whether you or your family members worked for the military or in jails, whether you have supported a terrorist group and even the Nazi party. The questions aren t here because the Immigration Service suspects that you are a terrorist they are on all applications because they are so important to American values. Many people who are not terrorists might answer some questions yes. For example, have you ever been present when someone was forcibly removed from her home? Unless it was while you were a terrorist or were helping to persecute someone, go ahead and answer yes without fear that it will cause a problem. If you were a terrorist or persecutor, you will not be granted U status. If you answer yes to one of the following questions, please explain on a separate piece of paper. See detailed instructions at the end of this packet. Yes No Have you ever helped or supported: a. Hijacking or wrecking an airplane, ship, or other vehicle X b. Kidnapping or hostage taking? X c. Murder? X d. Using a gun to harm people or property? X e. Using biological, chemical or nuclear weapons to harm people or property? X 2

3 Have you ever supported an organization that: a. Is a terrorist organization? X b. Hijacked or wrecked an airplane, ship, or other vehicle X c. Kidnapped or taken hostages? X d. Murdered? X e. Used a gun to harm people or property? X f. Used biological, chemical or nuclear weapons to harm people or property? X g Worked in support of a terrorist group? X Do you plan to do any of the following? a. Spying? X b. Work to overthrow the U.S. government? X c. Do any work to spy, destroy or violate the laws about sending information X or goods out of the U.S.? Have you been a member of the Communist Party without being forced to? X Did you help the Nazis between 1933 and 1945? X Have you ever helped with: a. Torture or mass killing? X b. Killing, beating or injuring anyone? X c. Forcing people from their homes? X d. Forcing someone to be touched in a sexual way or to have sex. X e. Forcing someone not to express his or her religion? X f. Harming someone because of his or her race, religion, ethnicity, social group X or political opinion? Have you ever been present when any person was: a. Killed, tortured, beaten or injured? X b. Forcibly moved from his or her home? X c. Forced to have sex, or be touched in a sexual way? X Have you or a member of your family ever served in or been involved with: a. Any military, police, guerrilla, revolutionary, or vigilante group? X b. Any prison, jail, or other place that held prisoners? X c. Any organization or unit in which the members might possess or use weapons? X Have you ever gotten military or military-type training? X QUESTIONS ABOUT DEPORTATION a. Has a removal, exclusion, rescission or deportation process been started against X you, and not ended yet? b. Has one of these processes ever been started against you? X c. Have you ever been removed, excluded or deported? X d. Have you ever been ordered removed or deported by a judge or at the border X e. Have you ever applied for a visa (like a tourist visa) and your application was denied? X OR tried to get into the U.S. at the border or an airport, and you were not permitted to come in? X f. Have you stayed in the U.S. after being granted Voluntary Departure by an X 3

4 Immigration Judge? Has a court found that you violated INA section 274(C)? X Have you lied on an application, or to get a visa, or to enter to the U.S.? X Have you left the U.S. to avoid going into the U.S. military? X Have you ever had a J visa, and are required to stay outside the U.S. for two years? X Have you ever taken or kept a U.S. citizen child outside the U.S. to keep him or her X away from a U.S. citizen relative who has custody of the child? Do you believe that you are permitted to be married to more than one person at a time, X and do you plan to be married to more than one person while you are in the U.S.? Have you come into the United States by hiding in boat, truck, plane, bus, or car X without the owner or operator of the vehicle knowing about it? a. Do you have a serious disease that could spread to other people? X b. Do you have a condition that could make you a danger to yourself or other people? X c. Have you ever had a problem with drugs? X Questions About Immediate Relatives 1. Spouse 2. Child 3. Child 4. Child 4

5 5. Child 6. Child U-Visa Initial Document Checklist (This list is a starting point to assist you in collecting relevant documentation to support your U-Visa petition. More documents may be requested on an as-needed basis) - Valid Passport - Personal Declaration (write a chronological account of your experience, we will review, and reform it as necessary. This may require several revisions). - Letter from any Victim Compensation program of which you have taken or been offered benefits as a victim of crime - Police Report of the crime - Protection orders (if any) - Court documents relating to prosecution of the criminal case (if any) - Letter from therapist/mental health professional(s) - Declarations from friends, family, acquaintances, that describes the impact that the crime had on you (we will review, and reform it as necessary. These declarations may require some revision). - Other additional relevant documentation that supports that you were a victim of qualifying criminal activity, and that you have been/will continue to be helpful to law enforcement/prosecution. This may include: o news articles, o photographs of any injury sustained, - If you do not have a valid passport, provide any official identification documents with your name, date of birth, (driver s license, consular ID card, birth certificate, etc). 5