Petition For U Nonimmigrant Status 918 I

User Manual: 918

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Page Count: 11

Form I-918 02/07/17 N Page 1 of 11
To be completed by an
attorney or accredited
representative (if any).
START HERE - Type or print in black or blue ink.►
Part 1. Information About You
(Person filing this
petition as a victim)
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c. Middle Name
Safe Mailing Address (if other than Home Address)
Street Number
and Name
4.b.
4.d. City or Town
4.e. State 4.f. ZIP Code
4.c. Ste. Flr.Apt.
Street Number
and Name
3.a.
3.c. City or Town
3.d. State 3.e. ZIP Code
3.b. Ste. Flr.Apt.
Home Address
In Care Of Name
Other Names Used (Include maiden name, nicknames, and
aliases, if applicable)
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)
2.c. Middle Name
4.a.
Province
4.g.
Postal Code4.h.
4.i. Country
For
USCIS
Use
Only
Action Block
Receipt
U.S.
Embassy
Consulate
Validity Dates (mm/dd/yyyy)
To: / / /
From: / / /
Wait Listed
Stamp Number Date (mm/dd/yyyy)
Remarks
3.f.
Postal Code3.g.
Province
3.h. Country
Alien Registration Number (A-Number) (if any)
6.
USCIS Online Account Number (if any)7.
5.
►A-
U.S. Social Security Number (if any)
Other Information
MarriedSingle Divorced
Marital Status
Widowed
8.
►
►
USCIS
Form I-918
OMB No. 1615-0104
Expires 02/28/2019
Petition for U Nonimmigrant Status
Department of Homeland Security
U.S. Citizenship and Immigration Services
Attorney or Accredited Representative
USCIS Online Account Number (if any)
Attorney State Bar Number
(if applicable)
Select this box if
Form G-28 is
attached.
Form I-918 02/07/17 N Page 2 of 11
I am under 16 years of age.
I am submitting Form I-918, Supplement B, U
Nonimmigrant Status Certification, from a certifying
official.
I possess information concerning the criminal activity of
which I was a victim.
Part 1. Information About You (continued)
12.
15.
17.
16.
18.
19.a.
19.b.
20.
1.
2.
3.
4.
5.
6.
7.a.
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Select "Yes" or "No," as appropriate, for each of the following
questions.
I was or am in immigration proceedings.
The crime of which I am a victim occurred in the United
States (including Indian country and military installations)
or violated the laws of the United States.
I have suffered substantial physical or mental abuse as a
result of having been a victim of this criminal activity.
I am a victim of criminal activity listed in the INA at
section 101(a)(15)(U)(iii).11.
Date of Issuance for Passport or Travel Document
(mm/dd/yyyy)
Form I-94 Arrival-Departure Record Number
Passport Number
Travel Document Number
Country of Issuance for Passport or Travel Document
Expiration Date for Passport or Travel Document
(mm/dd/yyyy)
13.
Country of Citizenship or Nationality
14.
Country of Birth
Date of Last Entry into the United States
(mm/dd/yyyy)
22.
Place and Date of Last Entry into the United States and Date
Authorized Stay Expired
Current Immigration Status
7.c.
Exclusion Date (mm/dd/yyyy)
Exclusion Proceedings
Removal Date (mm/dd/yyyy)
Removal Proceedings
7.b.
If you answered "Yes," select the type of proceedings. If you
were in proceedings in the past and are no longer in proceedings,
provide the date of action. If you are currently in proceedings,
type or print “Current” in the appropriate date field. Select all
applicable boxes. Use the space provided in Part 8. Additional
Information to provide an explanation.
Part 2. Additional Information About You
Answering “Yes” to the following questions below requires
explanations and supporting documentation. Attach relevant
documents in support of your claims that you are a victim of
criminal activity listed in the Immigration and Nationality Act
(INA) section 101(a)(15)(U)(iii). You must also attach a
personal narrative statement describing the criminal activity of
which you are a victim. If you are only petitioning for U
derivative status for qualifying family members subsequent to
your (the principal petitioner) initial filing, you are not required
to submit evidence supporting the original petition with the new
Form I-918.
Rescission Proceedings7.e.
Judicial Date (mm/dd/yyyy)
7.f.
Rescission Date (mm/dd/yyyy)
Judicial Proceedings
Deportation Proceedings
Deportation Date (mm/dd/yyyy)
7.d.
►
10. Date of Birth (mm/dd/yyyy)
9. Gender Male Female
If you need extra space to complete Part 2., use the space
provided in Part 8. Additional Information.
State
City or Town
21. Date Authorized Stay Expired (mm/dd/yyyy)
NoYes
Form I-918 02/07/17 N Page 3 of 11
9.a.
10.c.
Date of Entry (mm/dd/yyyy)
10.b.
Status at the Time of Entry (for example, F-1 student,
B-2 tourist, entered without inspection)
10.d.
City or Town
10.a.
City or Town
9.c.
9.d. Status at the Time of Entry (for example, F-1 student,
B-2 tourist, entered without inspection)
9.b.
Date of Entry (mm/dd/yyyy)
Part 2. Additional Information About You
(continued)
If you are outside of the United States, provide the U.S.
Consulate or inspection facility or a safe foreign mailing
address you want notified if this petition is approved.
Pre-Flight Inspection
U.S. Consulate
Type of Office (Select only one box):
Port-of-Entry
11.a.
State
State
Place of Entry into the United States
Place of Entry into the United States
City or Town
8.c.
8.d.
8.b.
Status at the Time of Entry (for example, F-1 student,
B-2 tourist, entered without inspection)
State
Place of Entry into the United States
Safe Foreign Address Where You Want Notification Sent
(if other than U.S. Consulate, Pre-Flight Inspection, or
Port-of-Entry)
12.c. City or Town
12.d.
Postal Code12.e.
Province
12.f. Country
Street Number
and Name
12.a.
12.b. Ste. Flr.Apt.
Part 3. Processing Information
Answer the following questions about yourself. For the
purposes of this petition, you must answer "Yes" to the
following questions, if applicable, 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.
NOTE: If you answer “Yes” to ANY question in Part 3.,
provide an explanation in the space provided in Part 8.
Additional Information.
NOTE: Answering "Yes" does not necessarily mean that U.S.
Citizenship and Immigration Services (USCIS) will deny your
Petition for U Nonimmigrant Status.
Been arrested, cited, or detained by any law enforcement
officer (including Department of Homeland Security (DHS),
former Immigration and Naturalization Service (INS), and
military officers) for any reason?
Committed a crime or offense for which you have not
been arrested?
1.a.
1.b.
Yes No
Yes No
Have you EVER:
Been charged with committing any crime or offense?
Been convicted of a crime or offense (even if the
violation was subsequently expunged or pardoned)?
1.d.
1.c.
Yes No
Yes No
11.d.
11.b.
11.c.
City or Town
State
Country
Been placed in an alternative sentencing or a rehabilitative
program (for example, diversion, deferred prosecution,
withheld adjudication, deferred adjudication)?
1.e.
Yes No
Provide the date of entry, place of entry, and status under
which you entered the United States for each entry during
the five years preceding the filing of this petition.
8.a. Date of Entry (mm/dd/yyyy)
Form I-918 02/07/17 N Page 4 of 11
Received a suspended sentence, been placed on probation,
or been paroled?
1.f.
Yes No
Part 3. Processing Information (continued)
Outcome or disposition (for example, no charges filed,
charges dismissed, jail, probation)
Where were you arrested, cited, detained, or charged?
2.c.
2.f.
Country
2.d.
City or Town
2.e.
State
Why were you arrested, cited, detained, or charged?2.a
Date of arrest, citation, detention, or charge (mm/dd/yyyy)2.b.
Information About Arrests, Citations, Detentions, or Charges
Exercised diplomatic immunity to avoid prosecution for a
criminal offense in the United States?
1.i.
Yes No
Been in jail or prison?
Been the beneficiary of a pardon, amnesty, rehabilitation,
or other act of clemency or similar action?
1.g.
1.h.
Yes No
Yes No
Outcome or disposition (for example, no charges filed,
charges dismissed, jail, probation)
Why were you arrested, cited, detained, or charged?
Where were you arrested, cited, detained, or charged?
3.a
3.c.
Date of arrest, citation, detention, or charge (mm/dd/yyyy)3.b.
3.f.
Country
3.d.
City or Town
3.e.
State
4.d. Illicitly trafficked in any controlled substance or knowingly
assisted, abetted, or colluded in the illicit trafficking of any
controlled substance? Yes No
4.c. Knowingly encouraged, induced, assisted, abetted, or
aided any alien to try to enter the United States illegally?
Yes No
4.b. Engaged in any unlawful commercialized vice, including,
but not limited to, illegal gambling? Yes No
4.a.
Have you EVER:
Engaged in, or do you intend to engage in, prostitution or
procurement of prostitution? Yes No
Have you EVER committed, planned or prepared, participated
in, threatened to, attempted to, conspired to commit, gathered
information for, or solicited funds for any of the following:
5.a. Hijacking or sabotage of any conveyance (including an
aircraft, vessel, or vehicle)? Yes No
5.b. Seizing or detaining, and threatening to kill, injure, or
continue to detain, another individual in order to compel a
third person (including a governmental organization) to
do or abstain from doing any act as an explicit or implicit
condition for the release of the individual seized or
detained? Yes No
The use of any firearm with intent to endanger, directly or
indirectly, the safety of one or more individuals or to
cause substantial damage to property?
5.d.
Yes No
Assassination?5.c. Yes No
The use of any biological agent, chemical agent, nuclear
weapon or device, explosive, or other weapon or
dangerous device, with intent to endanger, directly or
indirectly, the safety of one or more individuals or to
cause substantial damage to property?
5.e.
Yes No
Have you EVER been a member of, solicited money or members
for, provided support for, attended military training (as defined in
section 2339D(c)(1) of Title 18, United States Code) by or on
behalf of, or been associated with any other group of two or
more individuals, whether organized or not, which has been
designated as, or has engaged in or has a subgroup which has
been designated as, or has engaged in:
A terrorist organization under section 219 of the INA?
6.a.
Yes No
Hijacking or sabotage of any conveyance (including an
aircraft, vessel, or vehicle)?
6.b.
Yes No
If you answered “Yes” to any of the above questions, respond to
the questions below to provide additional details. If you need
extra space, use the space provided in Part 8. Additional
Information.
Form I-918 02/07/17 N Page 5 of 11
Part 3. Processing Information (continued)
Seizing or detaining, and threatening to kill, injure, or
continue to detain, another individual in order to compel a
third person (including a governmental organization) to
do or abstain from doing any act as an explicit or implicit
condition for the release of the individual seized or
detained?
Soliciting money or members or otherwise providing
material support to a terrorist organization?
6.g.
Yes No
6.f.
Yes No
The use of any biological agent, chemical agent, nuclear
weapon or device, explosive, or other weapon or dangerous
device, with intent to endanger, directly or indirectly, the
safety of one or more individuals or to cause substantial
damage to property?
The use of any firearm with intent to endanger, directly or
indirectly, the safety of one or more individuals or to cause
substantial damage to property?
6.e.
Yes No
6.c.
Yes No
Assassination?6.d. Yes No
Espionage?
Have you EVER been or do you continue to be a member
of the Communist or other totalitarian party, except when
membership was involuntary?
Solely, principally, or incidentally in any activity related
to espionage or sabotage or to violate any law involving
the export of goods, technology, or sensitive information?
7.c.
8.
Yes No
Yes No
Any unlawful activity, or any activity the purpose of
which is in opposition to, or the control, or overthrow of
the government of the United States? Yes No
7.b.
Yes No
Do you intend to engage in the United States in:
7.a.
Killing any person? Yes No10.b.
NOTE: If you answered "Yes" to any question in Item
Numbers 10.a. - 10.g., please describe the circumstances in
Part 8. Additional Information.
Limiting or denying any person's ability to exercise
religious beliefs? Yes No
10.e.
The persecution of any person because of race, religion,
national origin, membership in a particular social group,
or political opinion? Yes No
10.f.
Displacing or moving any person from their residence by
force, threat of force, compulsion, or duress?
Yes No
10.g.
Engaging in any kind of sexual conduct or relations with
any person who was being forced or threatened?
Yes No
10.d.
Intentionally and severely injuring any person?
Yes No
10.c.
Have you EVER advocated that another person commit
any of the acts described in the preceding question, urged,
or encouraged another person, to commit such acts?
In any way compelled or forced to engage in any kind of
sexual contact or relations?
Displaced or moved from his or her residence by force,
compulsion, or duress?
Yes No
Yes No
Yes No
Intentionally killed, tortured, beaten, or injured?
Have you EVER been present or nearby when any person was:
12.a.
12.b.
12.c.
Yes No
11.
Have you EVER, during the period of 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, ordered, incited, assisted or
otherwise participated in the persecution of any person
because of race, religion, nationality, membership in a
particular social group, or political opinion?
9.
Yes No
Served in, been a member of, assisted in, or participated
in any military unit, paramilitary unit, police unit, self-
defense unit, vigilante unit, rebel group, guerilla group,
militia, or other insurgent organization?
Have you EVER:
13.a.
Yes No
Acts involving torture or genocide? Yes No10.a.
Have you EVER ordered, incited, called for, committed, assisted,
helped with, or otherwise participated in any of the following:
Form I-918 02/07/17 N Page 6 of 11
Part 3. Processing Information (continued)
Served in, been a member of, assisted in, or participated
in any group, unit, or organization of any kind in which
you or other persons transported, possessed, or used any
type of weapon?
13.c.
Yes No
NOTE: If you answered "Yes" to any question in Item
Numbers 13.a. - 13.c., please describe the circumstances in
Part 8. Additional Information.
Been a member of, assisted in, or participated in any
group, unit, or organization of any kind in which you or
other persons used any type of weapon against any person
or threatened to do so?
NOTE: If you answered "Yes" to any question in Item
Numbers 14.a. - 14.c., please describe the circumstances in
Part 8. Additional Information.
Assisted or participated in selling or providing weapons to
any person who to your knowledge used them against
another person, or in transporting weapons to any person
who to your knowledge used them against another
person?
14.c.
Yes No
Yes No
14.b.
Received any type of military, paramilitary, or weapons
training?
14.a.
Yes No
Have you EVER:
Are you NOW under a final order or civil penalty for
violating section 274C of the INA (producing and/or
using false documentation to unlawfully satisfy a
requirement of the INA)?
22.
Yes No
Have you EVER been granted voluntary departure by an
immigration officer or an immigration judge and failed to
depart within the allotted time?
21.
Yes No
Have you EVER had removal, exclusion, rescission, or
deportation proceedings initiated against you?
17.
Yes No
Recruited, enlisted, conscripted, or used any person under
15 years of age to serve in or help an armed force or group?
Are you NOW in removal, exclusion, rescission, or
deportation proceedings?
16.
Yes No
Used any person under 15 years of age to take part in
hostilities, or to help or provide services to people in
combat?
15.b.
Yes No
15.a.
Yes No
Have you EVER:
Have you EVER left the United States to avoid being
drafted into the U.S. Armed Forces or U.S. Coast Guard?
24.
Yes No
Have you EVER been a J nonimmigrant exchange visitor
who was subject to the 2-year foreign residence
requirement and not yet complied with that requirement
or obtained a waiver of such?
25.
Yes No
Have you EVER, by fraud or willful misrepresentation of
a material fact, sought to procure or procured a visa or
other documentation, for entry into the United States or
any immigration benefit?
23.
Yes No
Have you EVER detained, retained, or withheld the
custody of a child, having a lawful claim to United States
citizenship, outside the United States from a United States
citizen granted custody?
Do you NOW have a communicable disease of public
health significance?
29.a.
29.b.
29.c.
Do you NOW have or have you EVER had a physical or
mental disorder and behavior (or a history of behavior
that is likely to recur) associated with the disorder which
has posed or may pose a threat to the property, safety, or
welfare of yourself or others?
Are you NOW or have you EVER been a drug abuser or
drug addict?
Yes No
Yes No
Yes No
Have you EVER entered the United States as a stowaway?28.
Yes No
Do you plan to practice polygamy in the United States?
26.
27.
Yes No
Yes No
Have you EVER been removed, excluded, or deported
from the United States?
18.
Yes No
Have you EVER been denied a visa or denied admission
to the United States?
Have you EVER been ordered to be removed, excluded,
or deported from the United States?
19.
20.
Yes No
Yes No
Served in any prison, jail, prison camp, detention facility,
labor camp, or any other situation that involved detaining
persons?
13.b.
Yes No
Form I-918 02/07/17 N Page 7 of 11
2. Date of Birth (mm/dd/yyyy)
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c. Middle Name
Part 4. Information About Your Spouse and/or
Children
If you need extra space to complete Part 4., use the space
provided in Part 8. Additional Information.
Country of Birth3.
4.
Current Location
5.
Relationship
11.a. Family Name
(Last Name)
11.b. Given Name
(First Name)
11.c. Middle Name
12. Date of Birth (mm/dd/yyyy)
13. Country of Birth
14.
Current Location
15.
Relationship
6.a. Family Name
(Last Name)
6.b. Given Name
(First Name)
6.c. Middle Name
8. Country of Birth
7. Date of Birth (mm/dd/yyyy)
9.
Current Location
10.
Relationship
21.a. Family Name
(Last Name)
21.b. Given Name
(First Name)
21.c. Middle Name
22. Date of Birth (mm/dd/yyyy)
23. Country of Birth
24.
Current Location
25.
Relationship
16.a. Family Name
(Last Name)
16.b. Given Name
(First Name)
16.c. Middle Name
18. Country of Birth
17. Date of Birth (mm/dd/yyyy)
19.
Current Location
20.
Relationship
NOTE: If you answered “Yes” to 26., you must
complete and include Supplement A for each family
member for whom you are petitioning.
Yes No
I am petitioning for one or more qualifying family
members.
Filing On Behalf of Family Members
26.
Form I-918 02/07/17 N Page 8 of 11
Part 5. Petitioner's Statement, Contact
Information, Declaration, and Signature
At my request, the preparer named in Part 7.,
2.
,
The interpreter named in Part 6. read to me every
question and instruction on this petition and my answer
to every question in
1.b.
a language in which I am fluent, and I understood
everything.
,
NOTE: Select the box for either 1.a. or 1.b. If applicable,
select the box for 2.
1.a. I can read and understand English, and I have read and
understand every question and instruction on this
petition and my answer to every question.
Petitioner's Statement
NOTE: Read the Penalties section of the Form I-918
Instructions before completing this part.
Petitioner's Daytime Telephone Number3.
Petitioner's Contact Information
5. Petitioner's Email Address (if any)
Petitioner's Mobile Telephone Number (if any)4.
I understand that USCIS may require me to appear for an
appointment to take my biometrics (fingerprints, photograph,
and/or signature) and, at that time, if I am required to provide
biometrics, I will be required to sign an oath reaffirming that:
Petitioner's Declaration and Certification
Copies of any documents I have submitted are exact
photocopies of unaltered, original documents, and I understand
that USCIS may require that I submit original documents to
USCIS at a later date. Furthermore, I authorize the release of
any information from any of my records that USCIS may need
to determine my eligibility for the immigration benefit I seek.
prepared this petition for me based only upon
information I provided or authorized.
1) I provided or authorized all of the information
contained in, and submitted with, my petition;
2) I reviewed and understood all of the information in,
and submitted with, my petition; and
3) All of this information was complete, true, and
correct at the time of filing.
I certify, under penalty of perjury, that all of the information in
my petition and any document submitted with it were provided
or authorized by me, that I reviewed and understand all of the
information contained in, and submitted with, my petition, and
that all of this information is complete, true, and correct.
Petitioner's Signature
Petitioner's Signature6.a.
6.b. Date of Signature (mm/dd/yyyy)
NOTE TO ALL PETITIONERS: If you do not completely
fill out this petition or fail to submit required documents listed
in the Instructions, USCIS may deny your petition.
NOTE: A parent or legal guardian may sign for a person who
is less than 14 years of age. A legal guardian may sign for a
mentally incompetent person.
Part 6. Interpreter's Contact Information,
Certification, and Signature
Interpreter's Full Name
1.a. Interpreter's Family Name (Last Name)
1.b. Interpreter's Given Name (First Name)
Interpreter's Business or Organization Name (if any)2.
Provide the following information about the interpreter.
I further authorize release of information contained in this
petition, in supporting documents, and in my USCIS records to
other entities and persons where necessary for the
administration and enforcement of U.S. immigration laws.
Form I-918 02/07/17 N Page 9 of 11
Interpreter's Mailing Address
3.c. City or Town
3.d. State 3.e. ZIP Code
3.f.
Postal Code3.g.
Province
3.h. Country
Street Number
and Name
3.a.
3.b. Ste. Flr.
Apt.
Interpreter's Daytime Telephone Number
6.
4.
Interpreter's Email Address (if any)
Interpreter's Contact Information
Interpreter's Certification
I certify, under penalty of perjury, that:
I am fluent in English and
Interpreter's Mobile Telephone Number (if any)5.
Interpreter's Signature (sign in ink)7.a.
7.b.
Interpreter's Signature
Date of Signature (mm/dd/yyyy)
,
which is the same language specified in Part 5., 1.b., and I have
read to this petitioner in the identified language every question
and instruction on this petition and his or her answer to every
question. The petitioner informed me that he or she understands
every instruction, question, and answer on the petition,
including the Petitioner's Declaration and Certification, and
has verified the accuracy of every answer.
Part 6. Interpreter's Contact Information,
Certification, and Signature (continued) Part 7. Contact Information, Declaration, and
Signature of the Person Preparing this Petition, if
Other Than the Petitioner
Preparer's Full Name
Provide the following information about the preparer.
1.a. Preparer's Family Name (Last Name)
1.b. Preparer's Given Name (First Name)
Preparer's Business or Organization Name (if any)2.
Preparer's Mailing Address
3.c. City or Town
3.d. State 3.e. ZIP Code
3.f.
Postal Code3.g.
Province
3.h. Country
Street Number
and Name
3.a.
3.b. Ste. Flr.Apt.
Preparer's Contact Information
Preparer's Daytime Telephone Number
6.
4.
Preparer's Email Address (if any)
Preparer's Mobile Telephone Number (if any)5.
Form I-918 02/07/17 N Page 10 of 11
Preparer's Statement
I am an attorney or accredited representative and my
representation of the petitioner in this case
I am not an attorney or accredited representative but
have prepared this petition on behalf of the petitioner
and with the petitioner's consent.
NOTE: If you are an attorney or accredited
representative whose representation extends beyond
preparation of this petition, you may be obliged to
submit a completed Form G-28, Notice of Entry of
Appearance as Attorney or Accredited Representative,
with this petition.
7.a.
7.b.
Preparer's Certification
By my signature, I certify, under penalty of perjury, that I
prepared this petition at the request of the petitioner. The
petitioner then reviewed this completed petition and informed
me that he or she understands all of the information contained
in, and submitted with, his or her petition, including the
Petitioner's Declaration and Certification, and that all of this
information is complete, true, and correct. I completed this
petition based only on information that the petitioner provided
to me or authorized me to obtain or use.
Preparer's Signature
Preparer's Signature (sign in ink)8.a.
8.b. Date of Signature (mm/dd/yyyy)
extends
of this petition.
does not extend beyond the preparation
Form I-918 02/07/17 N Page 11 of 11
Part 8. Additional Information
3.d.
If you need extra space to provide any additional information
within this petition, use the space below. If you need more
space than what is provided, you may make copies of this page
to complete and file with this petition or attach a separate sheet
of paper. Include your name and A-Number (if any) at the top
of each sheet; indicate the Page Number, Part Number, and
Item Number to which your answer refers; and sign and date
each sheet.
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c. Middle Name
2. A-Number (if any) ►A-
3.a. Page Number 3.b. Part Number 3.c. Item Number 6.a. Page Number 6.b. Part Number 6.c. Item Number
6.d.
4.d.
4.a. Page Number 4.b. Part Number 4.c. Item Number
5.d.
5.a. Page Number 5.b. Part Number 5.c. Item Number
7.a. Page Number 7.b. Part Number 7.c. Item Number
7.d.

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