Naturalization Questionnaire

Step 1 of 12

About You (The Applicant)

Full name:

First Middle Last

All other names used (maiden names, names by previous marriages):

First

Middle

Last

Gender

Male

Female

Date of birth

Country of birth

Citizenship/nationality

Alien Registration Number (if applicable)

US Social Security Number (if applicable)

Phone Number(s)

Are you Hispanic or Latino?

Hispanic or Latino

Not Hispanic or Latino

Race

Asian

Black or African-American

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander

White

Height

Units:

Weight

Units:

Eye color

Black

Blue

Brown

Gray

Green

Hazel

Maroon

Pink

Unknown/Other

Hair Color

Bald (no hair)

Black

Blond

Brown

Gray

Red

Sandy

White

Unknown/Other

About where you've lived

Information on applicant’s residences for the last five years:

Current address

Street Address Apt/Ste/Flr Unit# City State / Province / Region ZIP / Postal Code Country

Date moved to this address:

Is your mailing address different from the one above?

Yes

In Care Of Name (if any)

Mailing address:

Street Address Apt/Ste/Flr Unit# City State / Province / Region ZIP / Postal Code Country

Last prior address:

Street Address Apt/Ste/Flr Unit# City State / Province / Region ZIP / Postal Code Country

Dates at this address: From:

To:

Next prior address, if applicable:

Street Address Apt/Ste/Flr Unit# City State / Province / Region ZIP / Postal Code Country

Dates at this address: From:

To:

Next prior address, if applicable:

Street Address Apt/Ste/Flr Unit# City State / Province / Region ZIP / Postal Code Country

Dates at this address: From:

To:

Applicant’s last address outside US of more than one year (not necessarily within last 5 years):

Street Address Apt/Ste/Flr Unit# City Province/Region Postal Code Country

Dates at this address: From:

To:

About your employment

Present employment (if applicable):

Employer Name

Employer Address

Street Address Apt/Ste/Flr Unit# City State / Province / Region ZIP / Postal Code Country

Occupation (specify)

Dates at this job: From:

to:

Is this your current job?

This is my current job.

Other employment(s) during last 5 years both inside or outside the U.S.:

Employer Name

Employer Address

Street Address Apt/Ste/Flr Unit# City State / Province / Region ZIP / Postal Code Country

Occupation (specify)

Dates at this job: From:

to:

Is this your current job?

This is my current job.

Other employment(s) during last 5 years both inside or outside the U.S.:

Employer Name

Employer Address

Street Address Apt/Ste/Flr Unit# City State / Province / Region ZIP / Postal Code Country

Occupation (specify)

Dates at this job: From:

to:

Is this your current job?

This is my current job.

Last occupation abroad (if not described already):

Employer Name

Employer Address

Street Address Apt/Ste/Flr Unit# City Province/Region Postal Code Country

Occupation (specify)

Dates at this job: From:

to:

Is this your current job?

This is my current job.

Your travel

How many days (24+ hours) did you spend outside the U.S. during the last 5 years:

How many 24+ hour trips did you take outside the U.S. during the last 5 years:

List all trips 24 hours or more long that you took outside the U.S. in the last 5 years, starting with the most recent:

Trip 1:

Date you left

Date you returned

Countries you visited

Trip 2:

Date you left

Date you returned

Countries you visited

Trip 3:

Date you left

Date you returned

Countries you visited

Trip 4:

Date you left

Date you returned

Countries you visited

Trip 5:

Date you left

Date you returned

Countries you visited

Trip 6:

Date you left

Date you returned

Countries you visited

Additional trips

About your parents

Were your parents married before your 18th birthday?

Yes

About your mother:

Is your mother a U.S. citizen?

Yes

Mother's name

First Middle Last

Mother's country of birth

Mother's date of birth

Date mother became a U.S. citizen

Mother's A-Number

About your father:

Is your father a U.S. citizen?

Yes

Father's name

First Middle Last

Father's country of birth

Father's date of birth

Date father became a U.S. citizen

Father's A-Number

About your marriage(s)

Marital status

Married

Single, never married

Divorced

Widowed

Marriage annulled

Legally separated

How many times have you been married (including annulled marriages and marriages to the same person)?

About your current husband or wife

Is your he/she a current member of the U.S. armed forces or Coast Guard?

Yes

His or her full name (for wife, give maiden name)

First Middle Last

All other names he/she has used:

First name

Middle name

Last name

His/her date of birth

Date of marriage between you and him/her

His/her current address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

His/her current employer:

Are they a U.S. citizen?

Yes

When did they become a U.S. citizen?

At birth

Other

Date of naturalization:

Citizenship/Nationality:

Alien Registration Number (if applicable)

Immigration status:

Lawful Permanent Resident

Other

If you selected "Other," please specify

How many times has he/she been married?

About your current spouse's former spouse

His or her legal name:

First Middle Last

His/her U.S. immigration status

U.S. Citizen

Lawful Permanent Resident

Other

If you selected "Other," please explain

His/her date of birth:

His/her country of birth:

His/her nationality:

Your current spouse's date of marriage to former spouse:

Date that marriage ended:

How did it end?

Divorced

Annulled

Spouse deceased

Other

If you selected "Other," please specify

About your former husband or wife

11. His or her full name (for wife, give maiden name)

First Middle Last

12. His/her immigration status when the marriage ended:

U.S. Citizen

Lawful Permanent Resident

Other

If you selected "Other," please explain

13. His/her date of birth

14. His/her country of birth

15. His/her nationality:

16. Date you married your former spouse

17. Date that marriage ended

17. Date of your former spouse's death

How did that marriage end (annulled, divorced, deceased, etc):

Divorced

Annulled

Spouse deceased

Other

If you selected "Other," please explain

About your children

How many children do you have (including adult children)?:

Child 1:

Name

First Middle Last

Date of birth

Country of birth

A-Number (if applicable)

What is your child's relationship to you?

Does he/she live with you?

Yes

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Child 2:

Name

First Middle Last

Date of birth

Country of birth

A-Number (if applicable)

What is your child's relationship to you?

Does he/she live with you?

Yes

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Child 3:

Name

First Middle Last

Date of birth

Country of birth

A-Number (if applicable)

What is your child's relationship to you?

Does he/she live with you?

Yes

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Child 4:

Name

First Middle Last

Date of birth

Country of birth

A-Number (if applicable)

What is your child's relationship to you?

Does he/she live with you?

Yes

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Child 5:

Name

First Middle Last

Date of birth

Country of birth

A-Number (if applicable)

What is your child's relationship to you?

Does he/she live with you?

Yes

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Background Questions

1. Have you ever claimed to be a U.S. citizen (in writing or any other way)?

Yes

2. Have you ever registered to vote in any Federal, state, or local election in the U.S.?

Yes

3. Have you ever voted in any Federal, state, or local election in the U.S.?

Yes

4a. Do you now have, or did you ever have, a hereditary title or an order of nobility in any foreign country?

Yes

b. If yes, are you willing to give up any inherited titles or orders of nobility that you have in a foreign country at your naturalization ceremony?

Yes

5. Have you ever been declared legally incompetent or been confined to a mental institution?

Yes

6. Do you owe any overdue Federal, state, or local taxes?

Yes

7a. Have you ever not filed a Federal, state, or local tax return since you became a lawful permanent resident?

Yes

7b. Did you consider yourself to be a “non-U.S. resident”?

Yes

8. Have you called yourself a “non-U.S. resident” on a Federal, state, or local tax return since you became a lawful permanent resident?

Yes

Your memberships

9a. Have you ever been a member of, involved in, or in any way associated with, any organization, association, fund, foundation, party, club, society, or similar group in the U.S. or in any other location in the world?

Yes

List ALL present and past membership in or affiliation with every organization, association, fund, foundation, party, club, society, or similar group in the US or in other places since your 16th birthday, including military service.

9b. Please provide the following information for EACH organization:

Name of organization

Purpose of group

Member from

Background questions, continued

10. Have you ever been a member of, or in any way associated (either directly or indirectly) with:

a. The Communist Party?

Yes

b. Any other totalitarian party?

Yes

c. A terrorist organization?

Yes

11. Have you ever advocated (either directly or indirectly) the overthrow of any government by force or violence?

Yes

12. Have you ever persecuted (directly or indirectly) any person because of race, religion, national origin, membership in a particular social group, or political opinion?

Yes

13. Between March 23, 1933 and May 8, 1945, did you work for or associate in any way (either directly or indirectly) with:

a. The Nazi government of Germany?

Yes

b. Any government in any area occupied by, allied with, or established with the help of the Nazi government of Germany?

Yes

c. Any German, Nazi, or S.S. military unit, paramilitary unit, self-defense unit, vigilante unit, citizen unit, police unit, government agency or office, extermination camp, concentration camp, prisoner of war camp, prison, labor camp, or transit camp?

Yes

14. Were you ever involved in any way with any of the following:

a. Genocide?

Yes

b. Torture?

Yes

c. Killing, or trying to kill, someone?

Yes

d. Badly hurting, or trying to hurt, a person on purpose?

Yes

e. Forcing, or trying to force, someone to have any kind of sexual contact or relations?

Yes

f. Not letting someone practice his or her religion?

Yes

15. Were you ever a member of, or did you ever serve in, help, or otherwise participate in, any of the following groups:

a. Military unit?

Yes

b. Paramilitary unit (a group of people who act like a military group but are not part of the official military)?

Yes

c. Police unit?

Yes

d. Self-defense unit?

Yes

e. Vigilante unit (a group of people who act like the police, but are not part of the official police)?

Yes

f. Rebel group?

Yes

g. Guerrilla group (a group of people who use weapons against or otherwise physically attack the military, police, government, or other people)?

Yes

h. Militia (an army of people, not part of the official military)?

Yes

i. Insurgent organization (a group that uses weapons and fights against a government)?

Yes

16. Were you ever a worker, volunteer, or soldier, or did you otherwise ever serve in any of the following:

a. Prison or jail?

Yes

b. Prison camp?

Yes

c. Detention facility (a place where people are forced to stay)?

Yes

d. Labor camp (a place where people are forced to work)?

Yes

e. Any other place where people were forced to stay?

Yes

17. Were you ever part of any group, or did you ever help any group, unit, or organization that used a weapon against any person, or threatened to do so?

Yes

a. When you were part of this group, or when you helped this group, did you ever use a weapon against another person?

Yes

b. When you were part of this group, or when you helped this group, did you ever tell another person that you would use a weapon against that person?

Yes

18. Did you ever sell, give, or provide weapons to any person, or help another person sell, give, or provide weapons to any person?

Yes

a. Did you know that this person was going to use the weapons against another person?

Yes

b. Did you know that this person was going to sell or give the weapons to someone who was going to use them against another person?

Yes

19. Did you ever receive any type of military, paramilitary (a group of people who act like a military group but are not part of the official military), or weapons training?

Yes

20. Did you ever recruit (ask), enlist (sign up), conscript (require), or use any person under 15 years of age to serve in or help an armed force or group?

Yes

21. Did you ever use any person under 15 years of age to do anything that helped or supported people in combat?

Yes

Criminal Activity

If any of questions 22-28 apply to you, you must answer “Yes” even if your records have been sealed, expunged, or otherwise cleared. You must disclose this information even if someone, including a judge, law enforcement officer, or attorney, told you that it no longer constitutes a record or told you that you do not have to disclose the information.

22. Have you ever committed, assisted in committing, or attempted to commit, a crime or offense for which you were NOT arrested?

Yes

23. Have you ever been arrested, cited, or detained by any law enforcement officer (including any immigration official or any official of the U.S. armed forces) for any reason?

Yes

24. Have you ever been charged with committing, attempting to commit, or assisting in committing a crime or offense?

Yes

25. Have you ever been convicted of a crime or offense?

Yes

26. Have you ever been placed in an alternative sentencing or rehabilitative program (ex. diversion, deferred prosecution, withheld adjudication, deferred adjudication)?

Yes

27a. Have you ever received a suspended sentence, been placed on probation, or been paroled?

Yes

27b. If yes, have you completed the probation or parole?

Yes

28a. Have you ever been in jail or prison?

Yes

If yes, how long were you in jail or prison?

Years

Months

Days

If you answered “Yes” to any of questions 22-28, please provide the following information for each incident: Why were you arrested, cited, detained, or charged? Date arrested, cited, detained, or charged. Where were you arrested, cited, detained, or charged (city, state, country)? Outcome or disposition of the arrest, citation, detention, or charge (ex. No charges filed, charges dismissed, jail, probation, etc.)

Why were you arrested, cited, detained, or charged?

Date arrested, cited, detained, or charged

Where were you arrested, cited, detained, or charged?

City State / Province / Region Country

Outcome or disposition of the arrest, citation, detention, or charge (ex. No charges filed, charges dismissed, jail, probation, etc.)

Why were you arrested, cited, detained, or charged?

Date arrested, cited, detained, or charged

Where were you arrested, cited, detained, or charged?

City State / Province / Region Country

Outcome or disposition of the arrest, citation, detention, or charge (ex. No charges filed, charges dismissed, jail, probation, etc.)

Why were you arrested, cited, detained, or charged?

Date arrested, cited, detained, or charged

Where were you arrested, cited, detained, or charged?

City State / Province / Region Country

Outcome or disposition of the arrest, citation, detention, or charge (ex. No charges filed, charges dismissed, jail, probation, etc.)

Why were you arrested, cited, detained, or charged?

Date arrested, cited, detained, or charged

Where were you arrested, cited, detained, or charged?

City State / Province / Region Country

Outcome or disposition of the arrest, citation, detention, or charge (ex. No charges filed, charges dismissed, jail, probation, etc.)

Why were you arrested, cited, detained, or charged?

Date arrested, cited, detained, or charged

Where were you arrested, cited, detained, or charged?

City State / Province / Region Country

Outcome or disposition of the arrest, citation, detention, or charge (ex. No charges filed, charges dismissed, jail, probation, etc.)

Have you ever:

a. Been a habitual drunkard?

Yes

b. Been a prostitute, or procured anyone for prostitution?

Yes

c. Sold or smuggled controlled substances, illegal drugs, or narcotics?

Yes

d. Been married to more than one person at the same time?

Yes

e. Married someone in order to obtain an immigration benefit?

Yes

f. Helped anyone to enter, or try to enter, the United States illegally?

Yes

g. Gambled illegally or received income from illegal gambling?

Yes

h. Failed to support dependents or to pay alimony?

Yes

i. Made any misrepresentation to obtain any public benefit in the United States?

Yes

U.S. Government interaction

31. Have you ever given any U.S. Government officials any information or documentation that was false, fraudulent, or misleading?

Yes

32. Have you ever lied to any U.S. government officials to gain entry or admission into the United States or to gain immigration benefits while in the United States?

Yes

33. Have you ever been removed, excluded, or deported from the United States?

Yes

34. Have you ever been ordered removed, excluded, or deported from the U.S.?

Yes

35. Have you ever been placed in removal, exclusion, rescission, or deportation proceedings?

Yes

36. Are removal, exclusion, rescission, or deportation proceedings (including administratively closed proceedings) currently pending against you?

Yes

37. Have you ever served in the U.S. armed forces?

Yes

38a. Are you currently a member of the U.S. armed forces?

Yes

38b. If yes, are you scheduled to deploy overseas, including to a vessel, within the next three months?

Yes

38c. If yes, are you currently stationed overseas?

Yes

39. Have you ever been court-martialed, administratively separated, or disciplined, or have you received an other-than-honorable discharge, while in the U.S. armed forces?

Yes

40. Have you ever been discharged from training or service in the U.S. armed forces because you were an alien?

Yes

41. Have you ever left the United States in order to avoid being drafted in the U.S. armed forces?

Yes

42. Have you ever applied for any kind of exemption from military service in the U.S. armed forces?

Yes

43. Have you ever deserted from the U.S. armed forces?

Yes

44a. Are you a male who lived in the United States at any time between your 18th and 26th birthdays (as anything other than a legal non-immigrant status)?

Yes

44b. When did you register for the Selective Service?

Selective Service number:

If you did not register for the Selective Service, and you are… i. Currently under 26 years of age: You must register with the Selective Service before you apply for Naturalization, and must fill in the above information (in 44a) ii. Currently 26-31 years of age: You must provide a statement explaining why you did not register, and request a status information letter from the Selective Service

45. Do you support the Constitution and form of Government of the United States?

Yes

46. Do you understand the full Oath of Allegiance to the United States?

Yes

47. Are you willing to take the full Oath of Allegiance to the United States?

Yes

48. If the law requires it, are you willing to bear arms on behalf of the United States?

Yes

49. If the law requires it, are you willing to perform noncombatant services in the U.S. armed forces?

Yes

50. If the law requires it, are you willing to perform work of national importance under civilian direction?

Yes

If you answer “No” to any of questions 45-50, you must include (on a separate sheet of paper) an explanation and provide evidence to support your answers.

Are there any other special details we should know about the answers you've given?

(This is for our use only, to help you with your case.)