Form I-360 04/12/18Page 1 of 19 For USCIS Use Only Petition for Amerasian, Widow(er), or Special Immigrant Department of Homeland Security U.S. Citizenship and Immigration ServicesUSCIS Form I-360 OMB No. 1615-0020 Expires 04/30/2020 START HERE - Type or print in black ink. Remarks: Action Block Sent Received Relocated Fee Stamp Resubmitted Petitioner/Applicant Interviewed Interviewed Beneficiary InterviewedBene "A" File ReviewedI-485 Filed Concurrently Returned Priority Date Consulate Classification Part 1. Information About Person or Organization Filing This Petition Family Name (Last Name)Your Full NameNOTE: You must complete Part 1. as the petitioner if you are filing this petition on behalf of another person. If you are a Violence Against Women Act (VAWA) self-petitioner or special immigrant juvenile, skip to Part 1., Item Number 7. Mailing AddressGiven Name (First Name)Middle Name City or TownStateZIP CodeStreet Number and NameApt.Flr.NumberSte.Postal Code CountryProvince In Care Of Name (if any) Organization Name (if applicable) U.S. Social Security Number (if any)Individual IRS Tax Number (if any)Alien Registration Number (A-Number) (if any) A- 1.2.4.5.3.6.USCIS Online Account Number (if any) Select this box if Form G-28 or G-28I is attached.Attorney State Bar Number (if applicable)Attorney or Accredited Representative USCIS Online Account Number (if any) To be completed by an Attorney or Accredited Representative (if any). (USPS ZIP Code Lookup) Form I-360 04/12/18Page 2 of 19 Alternate and/or Safe Mailing Address City or TownStateZIP CodeIn Care Of Name (if any)Street Number and NameApt.Flr.NumberSte.Postal Code CountryProvince If you are a VAWA self-petitioning spouse, child, parent, or a special immigrant juvenile and do not want U.S. Citizenship and Immigration Services (USCIS) to send notices about this petition to your home, you may provide an alternate and/or safe mailing address. Part 1. Information About Person or Organization Filing This Petition (continued) Part 2. Classification Requested Will the beneficiary be working as a minister? 1.(1)AmerasianSelect only one box.Special Immigrant Religious Worker Special Immigrant JuvenileWidow(er) of a U.S. citizen Special Immigrant based on employment with the Panama Canal Company, Canal Zone Government, or U.S. Government in the Canal Zone Self-Petitioning Spouse of Abusive U.S. citizen or Lawful Permanent Resident Special Immigrant G-4 International Organization Employee or Family Member or NATO-6 Employee or Family MemberSpecial Immigrant Armed Forces MemberSpecial Immigrant Physician K.VAWA Self-Petitioning Parent of a U.S. citizen son or daughter Special Immigrant Afghanistan or Iraq National who worked with the U.S. Armed Forces as a translatorSelf-Petitioning Child of Abusive U.S. citizen or Lawful Permanent ResidentSpecial Immigrant Iraq National who was employed by or on behalf of the U.S. GovernmentBroadcasters P.OtherSpecial Immigrant Afghanistan National who was employed by or on behalf of the U.S. Government or the International Security Assistance Force (ISAF) in Afghanistan O. Yes No 7.A.B.C.D.E.F.G.H.I.J.L.M.N.Provide the name of the classification below. Form I-360 04/12/18Page 3 of 19 Part 3. Information About the Person for Whom This Petition Is Being FiledFamily Name (Last Name)Your Full NameGiven Name (First Name)Middle Name Mailing Address Other InformationDate of Birth (mm/dd/yyyy) U.S. Social Security Number (if any) Country of BirthA- A-Number (if any)4.6.5.8.10.9.11.13.15.3.7.Marital Status SingleMarriedWidowedDivorcedComplete Item Numbers 8. - 15. if this person is in the United States. If an item number is not applicable or the answer is "none," leave the space blank. Provide information below for the passport or other document used at the time of last arrival to the United States.Current Nonimmigrant Status Country of Issuance for Passport or Travel DocumentExpiration Date for Passport or Travel Document Date of Last Arrival (mm/dd/yyyy)Form I-94 Number or I-95 Crewman's Landing PermitDate current status expired, or will expire, as shown on Passport NumberTravel Document Number(mm/dd/yyyy)If the person listed in Part 3. is outside the U.S., is ineligible to adjust status in the U.S., or does not wish to adjust status in the U.S., provide the following information about the U.S. Consulate at which the person prefers to apply for an immigrant visa. Part 4. Processing InformationCity or TownU.S. Consulate1.1.2.NOTE: On this petition, the "beneficiary" or "self-petitioner" means the person for whom this petition is being filed. If you provided an alternate and/or safe mailing address above, you must also complete Part 3.Form I-94 or I-95 (mm/dd/yyyy)A.Country B. City or TownStateZIP CodeIn Care Of Name (if any)Street Number and NameApt.Flr.NumberSte.Postal Code CountryProvince 12.14. Form I-360 04/12/18Page 4 of 19 If a U.S. address was provided in Part 3., type or print the person's foreign address below. If he or she does not maintain a foreign address, list the city or town and country of last foreign residence. If his or her native alphabet does not use Roman letters, type or print his or her name and foreign address in the native alphabet. Street Number and NameApt.Flr.NumberSte.Postal Code CountryCity or Town Gender of the beneficiary:If you answered "Yes" to Item A. in Item Number 4., how many?Has the beneficiary ever worked in the U.S. without permission? (If you are applying for a special immigrant juvenile status, you are not required to answer this item number.)Is an application for adjustment of status attached to this petition?Is the beneficiary in removal proceedings? Are you filing any other petitions or applications with this one?If you answer "Yes" to Item Numbers 5. - 6., provide an explanation in the space provided in Part 15. Additional Information. Yes Yes No Male Female Yes Yes 3.4.5.6.7. Part 4. Processing Information (continued)2. No No NoYour Full NameB.Mailing AddressA.Family Name (Last Name)Given Name (First Name)Middle Name A.B. Part 5. Information About the Spouse and Children of the Person for Whom This Petition Is Being FiledA-Number (if any) A- Country of Birth RelationshipDate of Birth (mm/dd/yyyy) Middle Name Given Name (First Name)Person 1Family Name (Last Name) Spouse Child2.NOTE: Depending on the classification you seek, you can either file this petition for another person or for yourself. On this petition, the "beneficiary" or "self-petitioner" means the person for whom this petition is being filed, whether that person is yourself or another person.If you are filing as a self-petitioning spouse, have any of your children filed separate self-petitions? Yes 1. No Province Form I-360 04/12/18Page 5 of 19 A-Number (if any) A- RelationshipPerson 2 Child3. Part 5. Information About the Spouse and Children of the Beneficiary (continued)Person 34.Person 45.Person 56.Person 67.Country of Birth Middle Name Given Name (First Name)Family Name (Last Name)A-Number (if any)A- Relationship ChildCountry of Birth Middle Name Given Name (First Name)Family Name (Last Name)A-Number (if any) A- Relationship ChildCountry of Birth Middle Name Given Name (First Name)Family Name (Last Name)A-Number (if any) A- Relationship ChildCountry of Birth Middle Name Given Name (First Name)Family Name (Last Name)A-Number (if any) A- Relationship ChildCountry of Birth Middle Name Given Name (First Name)Family Name (Last Name)Date of Birth (mm/dd/yyyy)Date of Birth (mm/dd/yyyy)Date of Birth (mm/dd/yyyy)Date of Birth (mm/dd/yyyy)Date of Birth (mm/dd/yyyy) Form I-360 04/12/18Page 6 of 19 Part 5. Information About the Spouse and Children of the Beneficiary (continued)Person 78.Person 89.Person 910. Part 6. Complete Only If Filing for an Amerasian Information About the Mother of the Amerasian Family Name (Last Name)Mother's Full NameGiven Name (First Name)Middle Name 1.2.Is the mother still alive? UnknownA.B.If you answered "Yes" to Item A. in Item Number 2., provide her address below. City or TownStateZIP CodeIn Care Of Name (if any)Street Number and NameApt.Flr.NumberSte.Postal Code CountryProvince A-Number (if any) A- Relationship ChildCountry of Birth