DOCUMENTS

1. Copy of Alien Registration Card (Green Card);
2. Two recent identical photos;
3. Copy of passport;
4. Copy of marriage license, if you are claiming eligibility for naturalization based on marriage to an U.S. citizen;

INFORMATION

1. Information about you
   1. Last name ____________ First Name _______________Middle Name_________
   2. Address in the U.S. ________________________________________

      _____________________________________________________________

   3. Date of Birth (mm/dd/yy)___________Country of Birth____________________
   4. Social Security Number______________________________________________
   5. A#____________________________
2. Basis for eligibility (Check one)

   1. __ I have been a permanent resident for at least five years;
   2. __ I have been a permanent resident for at least three years, and have been married to an U.S. citizen for those three years
   3. __ I am a permanent resident child of U.S. citizen parents;
   4. __ I am applying on the basis of qualifying military service in the armed forces of the U.S. and have attached completed forms N-426 and G-325B;
   5. __ Other (Section of Law _________________)

3. Additional information about you
   1. Date you became a permanent resident (mo/day/yr)___________________
   2. Port admitted with an immigrant visa or USCIS office where granted adjustment of status

      __________________________________

   3. Current citizenship________________________________
   4. Name on Alien Registration Card (if different than Part I.)__________________
   5. Other names used since you became a permanent resident___________________
   6. Sex(male)_____(female)_____, Height__________
   7. Marital Status (single)____(divorced)____(married)____(widowed)____
   8. Can you speak, read, and write English? (yes)______(no)______
   9. Have you ever been absent from the U.S. since becoming a permanent resident?
      (yes)_____ (no)_____
   
   If "yes". Complete the following:

   Date left the U.S._______________________

   Date returned _______________________

   Did absence last 6 months or more? (yes)___(no)___

   Destination _______________________

   Reason for Trip_______________________

4. Information about your residence and employment
   1. List your address in the last 5 years or since you became a permanent resident, whichever is less. Begin with your current address.

      (Street number)       (City)    (State)  (Zip code)    (Country)      From   To

      _________________________________________________________________

      _________________________________________________________________

      _________________________________________________________________

      _________________________________________________________________

      _________________________________________________________________

      _________________________________________________________________

      _________________________________________________________________

   2. List your employers during the last 5 years. List your present or most recent employer first.

      (Employer's name)       (Employer's address)       From    To    Occupation/Position

      _________________________________________________________________

      _________________________________________________________________

      _________________________________________________________________

      _________________________________________________________________

      _________________________________________________________________

      _________________________________________________________________

      _________________________________________________________________

5. Information about your marital history
   1. Total number of times you have been married____________
   2. Information about your current husband/wife

      (Last name)____________(First name)________________(Middle name)______

      (Address)

      _________________________________________________________________

      _________________________________________________________________

      (Date of birth)______________________

      (Country of birth)_____________________, (Citizenship)___________________

      (Social Security number)__________________________A#_________________

      (Immigration status, if not U.S. citizen)_________________________

      (Date of Naturalization)________________

      (Place of Naturalization)________________

   3. If you have ever been previously married, or if your current spouse has ever been previously married, please provide the following: Your prior spouse

      (Name)____________________________________

      (Date of marriage)___________________________

      (Date marriage ended)________________________

      (How marriage ended)________________________

      (Immigration status of prior spouse)_____________

      The prior spouse of your current spouse

      (Name)_____________________________________

      (Date of marriage)____________________________

      (Date marriage ended)_________________________

      (How marriage ended)_________________________

      (Immigration status of prior spouse)______________

6. Information about your children
   1. Total number of children_______
   2. Please provide the following information about your children:

      Name     DOB     Country of birth     Citizenship      A# Address (If different than yours)

      ____________________________________________________________________

      ____________________________________________________________________

      ____________________________________________________________________

      ____________________________________________________________________

      ____________________________________________________________________

7. Membership and organizations

   List your current and past membership in or affiliation with organization, association, fund, foundation, party, club, society or similar group in the U.S. or any other place. Include any military service in this part.

   Name of organization    Location    Dates of Membership    Nature of organization

   __________________________________________________________________

   __________________________________________________________________

   __________________________________________________________________

   __________________________________________________________________

8. Complete only if you checked "c" in part II.

9. How many of your parents are U.S. citizens? One__ Both__
10. Please provide the following information about one of your U.S. citizen parent(s):

    Last name_______________ First name________________ Middle name_________

    Address___________________________________________________

    __________________________________________________________

    __________________________________________________________

    Basis of citizenship (birth)____________

    (naturalization certificate number)______________________

    Relationship to you (natural parent)___________(adoptive parent)____________

    (parent of child legitimized after birth)__________________

    Date of adoption or legitimization_______________________________________

    Does this parent have legal custody of you? (yes)____(no)____