Application for Advance Processing of an Orphan Petition Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form I-600A OMB No. 1615-0028 Expires 12/31/2018 For USCIS Use Only The applicant is: Married Unmarried The applicant: WILL provide proper care to a child if admitted to the United States. WILL NOT provide proper care to a child if admitted to the United States. Received The state of the child's proposed residence: HAS preadoptive requirements. DOES NOT HAVE preadoptive requirements. Describe preadoption requirements (if any). The preadoption requirements: WERE met. HAVE NOT BEEN met. File Number Date of Favorable Determination Completed DD District Remarks Fee Stamp Trans In START HERE - Type or print legibly in black ink. This application is made by a prospective adoptive parent for advance processing of an orphan petition. Part 1. Information About You (Applicant) 1. Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) 2. Other Names You Have Used (including maiden name, nicknames, and aliases, if any) Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) 3. U.S. Mailing Address (if any) In Care Of Name Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code 4. Is your current U.S. mailing address the same as your U.S. physical address? Yes No If you answered "No" to Item Number 4., provide your U.S. physical address in Item Number 5. or your address abroad in Item Number 6., as appropriate. 5. U.S. Physical Address (if any) Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Form I-600A 12/23/16 N American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 12 Part 1. Information About You (Applicant) (continued) 6. Address Abroad (if any) Street Number and Name Apt. Ste. Flr. Number City or Town State Province Postal Code Country 7. Date of Birth (mm/dd/yyyy) 8. City/Town/Village of Birth 9. State or Province of Birth 10. Country of Birth 11. Information About U.S. Citizenship A. Are you a citizen of the United States? Yes No NOTE: If you answered "No," you may NOT file Form I-600A. See the What Are the Eligibility Requirements? section of the Form I-600A instructions for more information. B. How did you acquire your U.S. citizenship? Birth Parents Naturalization C. If you acquired your citizenship through your parents, have you obtained a Certificate of Citizenship in your own name? Yes If "Yes," provide the following information about your Certificate of Citizenship: Name Under Which the Certificate of Citizenship Was Issued Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) No Alien Registration Number (A-Number) (if any) Certificate of Citizenship Number ADate of Issuance (mm/dd/yyyy) D. If you acquired your citizenship through naturalization, provide the following information about your Certificate of Naturalization: Name Under Which the Certificate of Naturalization Was Issued Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) Place of Issuance A-Number (if any) Certificate of Naturalization Number ADate of Naturalization (mm/dd/yyyy) Place of Naturalization Form I-600A 12/23/16 N American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 12 Part 1. Information About You (Applicant) (continued) 12. Have you, or any person through whom you claimed citizenship, EVER lost U.S. citizenship? Yes No NOTE: If you answered "Yes," attach a detailed explanation on a separate sheet of paper; type or print 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. 13. What is your marital status? Married Widowed Divorced Single 14. How many times have you been married (including your current marriage, if applicable)? 15. Date of Current Marriage (if applicable) (mm/dd/yyyy) 17. Information About Your Current Spouse (if applicable) Family Name (Last Name) Given Name (First Name) 16. Place Where Current Marriage Occurred (if applicable) Middle Name (if applicable) Other Names Your Current Spouse Has Used (including maiden name, nicknames, and aliases, if any) Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) Date of Birth (mm/dd/yyyy) State or Province of Birth A-Number (if any) City/Town/Village of Birth ACountry of Birth Spouse's Immigration Status 18. How many times has your current spouse been married (including your current marriage, if applicable)? 19. Does your current spouse reside with you? If you answered "No," provide your current spouse's physical address in Item Number 20. 20. Your Current Spouse's Physical Address Street Number and Name Yes No Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code Country 21. How many persons 18 years of age or older, other than your current spouse (if married), reside with you? If you answered "1" or more, you MUST complete Form I-600A/I-600 Supplement 1, Listing of Adult Member of the Household, for each person. Form I-600A 12/23/16 N American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 12 Part 1. Information About You (Applicant) (continued) 22. Have you ever previously filed Form I-600A, Form I-600, Petition to Classify Orphan as an Immediate Relative, Form I-800A, Application for Determination of Suitability to Adopt a Child From a Convention Country, or Form I-800, Petition to Classify Convention Adoptee as an Immediate Relative? If "Yes," provide the following: A. Type of Application/Petition Filed Yes No B. Result - Check the box that best describes the action taken by USCIS and/or U.S. Department of State on your application and/or petition. Approved - Approval Date (mm/dd/yyyy) Denied - Denial Date (mm/dd/yyyy) NOTE: A copy of the denial notice must accompany this application. Other - Explain C. A detailed description of any previous Form I-600 or Form I-800 filing that resulted in a disruption prior to finalization of the adoption or that resulted in a completed adoption that was later dissolved either in the United States or abroad. NOTE: If you need extra space to complete this question, attach a separate sheet of paper; type or print your A-Number (if any) at the top of each sheet; include the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet. Duty of Disclosure You and your spouse (if married), must answer the following questions. See the Duty of Disclosu