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I-821 Application Form

I-821 Application for Temporary Protected Status (TPS)

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What is your reason for applying?
Are you also submitting an employment authorization application?
What is your current legal name?
Have you used any other name since you were born?
How can we contact you?
Is your current mailing address the same as your physical address?
What is your gender?
Where did you last enter the United States?
Are you now or have you ever been in an immigration process?
What is your current marital status?
Are you now the guardian of and accompanying another person who has been declared inadmissible and who has been certified by a medical examiner to be helpless due to illness, physical or mental disability, or infancy?
Do you now have a communicable disease of public health importance?
Do you 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 that has posed or may pose a threat to your property, safety or well-being? or other people?
Have you ever traveled to and entered a country other than your country of nationality or your last habitual residence before your last entry into the United States?
Have you ever voted illegally in a US federal, state, or local election?
Have you ever claimed to be a US citizen (in writing or otherwise)?
Have you ever been ordered deported and deported from the United States?
Have you ever voluntarily left the United States under a removal order?
Have you ever failed to attend or remain present in any immigration proceeding to determine your admissibility or deportability?
Has an immigration judge or the Board of Immigration Appeals ever determined that you made a frivolous asylum claim in the past?
Have you ever, by fraud or intentionally misrepresenting a material fact, sought to obtain a visa or other documentation, admission to the United States, or any other immigration benefit?
Have you ever helped another person enter the United States in violation of the law?
Have you ever entered the United States as a stowaway?
Has the former Immigration and Naturalization Service (INS) ever imposed civil monetary penalties on you, or has DHS, for presenting or using false documentation to obtain an immigration benefit?
Are you now subject to a final order for violation of section 274C (producing and/or using false documentation to unlawfully satisfy a requirement of the Immigration and Nationality Act)?
Have you ever been or are you a member of the communist party or other totalitarian party, except when membership was involuntary?
Have you ever participated in Nazi persecution or genocide?
Have you ever ordered, incited, aided or otherwise participated in the persecution of any person based on race, religion, nationality, membership in a particular social group or political opinion?
Have you ever ordered, incited, requested, committed, assisted or otherwise participated in acts involving torture or genocide?
Have you ever ordered, incited, requested, committed, assisted, or otherwise participated in the murder of anyone?
Have you ever ordered, incited, called upon, committed, assisted, or otherwise participated in the intentional and serious injury of any person?
Have you ever participated or are you currently involved in terrorist activities?
Have you ever ordered, incited, requested, committed, assisted, or otherwise participated in any type of sexual contact or relationship with anyone who was being forced or threatened?
Have you ever ordered, incited, requested, committed, assisted, or otherwise participated in limiting or denying the ability of any person to exercise religious beliefs?
Have you ever served in, been a member of, assisted in, or participated in any military unit, paramilitary unit, police unit, self-defense unit, surveillance unit, rebel group, guerrilla group, militia, or insurgent organization?
Have you ever served or worked in a prison, jail, prison camp, detention center, labor camp, or any other situation that involved the detention of people?
Have you ever been a member of, assisted in, or participated in any group, unit, or organization of any kind in which you or others used any type of weapon against anyone or threatened to do so?
Have you ever assisted or participated in the sale or supply of weapons to any person who, to the best of your knowledge, used them against another person, or in the transportation of weapons to any person who, to the best of your knowledge, used them against another person?
Have you ever received any type of military, paramilitary or weapons training?
Have you ever recruited, enlisted, recruited or used anyone under the age of 15 to serve or assist an armed force or group?
Have you ever used anyone under the age of 15 to participate in hostilities or to assist or provide services to people in combat?
Have you ever been responsible for or directly carried out particularly serious violations of religious freedom, as defined in section 3 of the International Religious Freedom Act of 1998 (22 U.S.C. section 6402) while serving as an official of a foreign government?
Are you the spouse or child of a foreign national who illegally trafficked a controlled substance?
Are you the spouse or child of an alien who aided, abetted, conspired, or colluded with others in the illegal trafficking of any controlled substance?
Are you now the spouse or child of a foreign national who committed or conspired to commit human trafficking crimes?
Are you now the spouse or child of, or are you yourself, an alien who knowingly aided, abetted, assisted, conspired, or colluded with a human trafficker?
Have you ever been convicted of any serious crime committed in the United States?
Have you ever been convicted of any misdemeanor committed in the United States?
Have you ever been convicted of any particularly serious crime committed inside or outside the United States?
Have you ever been convicted or committed acts that constitute the essential elements of a crime (other than a purely political crime)?
Have you ever been convicted of or committed acts that constitute the essential elements of a violation of any law relating to a controlled substance as defined in section 102 of the Controlled Substances Act?
Have you ever been convicted of or committed acts that constitute the essential elements of a conspiracy to violate any law relating to a controlled substance as defined in section 102 of the Controlled Substances Act?
Have you ever been convicted of two or more criminal offenses (other than purely political offenses) for which you received prison sentences that, combined, total five years or more?
Have you ever, whether in the United States or any other country, been arrested for breaking or violating any law or ordinance, excluding minor traffic violations?
Have you ever, whether in the United States or any other country, been cited, charged, or charged with violating or violating any law or ordinance, excluding minor traffic violations?
Have you ever, whether in the United States or any other country, been convicted, fined, imprisoned, placed on probation, received a suspended sentence, or a deferred adjudication for breaking or violating any law or ordinance, excluding violations traffic minors?
Have you ever been the beneficiary of a pardon, amnesty, rehabilitation decree, other act of clemency or similar action?
Have you ever committed a serious crime in the United States and claimed immunity from prosecution?
Have you ever committed serious criminal offenses outside the United States before you arrived in the United States?
Have you ever participated or plan to participate, solely, principally, or incidentally, in any activity that violates any United States law related to espionage or sabotage?
Have you ever participated or plan to participate, solely, principally or incidentally, in any activity to violate or evade any law prohibiting the export from the United States of goods, technology or confidential information?
Have you ever participated or plan to participate, solely, principally, or incidentally, in any other illegal activity in the United States?
Have you ever participated or plan to participate, exclusively, principally, or incidentally, in any activity the purpose of which is to oppose, control, or overthrow the Government of the United States by force, violence, or other unlawful means? including, but not limited to, participating in such activities, providing support to others involved in such activities, or being a member or representative of a terrorist organization?
Have you ever participated or are you currently participating or planning to participate in activities in the United States that would have potentially serious adverse foreign policy consequences for the United States?
Have you ever participated or are currently participating in activities that could be reasonable grounds for concluding that you pose a danger to the security of the United States?
Have you ever trafficked or are you trafficking any controlled substance?
Are you now or have you ever aided, abetted, conspired or colluded with others in the illegal trafficking of any controlled substance?
Within the previous five years, did you ever derive any financial or other benefit from the illegal activity of your spouse (including former spouses) or parents, and did you know, or reasonably should have known, that the financial or other benefit Another type was the product of such illicit activity?
Have you ever, in the last 10 years, been involved in prostitution or are you engaged in prostitution?
Have you ever, in the last 10 years (either directly or indirectly), hired or attempted to hire or import prostitutes or persons for the purposes of prostitution?
Have you ever, in the last 10 years, received, in whole or in part, the proceeds of prostitution?
Have you ever been or do you intend to be involved in any other trading vice?
Are you now or have you ever been a drug addict or drug addict?
Do you now practice polygamy?
Have you ever detained, withheld, or withheld custody of a child who has a legal claim to U.S. citizenship, outside of the United States, from a U.S. citizen to whom custody was granted?
Have you ever committed or conspired to commit human trafficking crimes, as defined in section 103 of the Trafficking and Violence Victims Protection Act of 2000, in the United States or outside the United States?
Have you ever knowingly aided, abetted, assisted, conspired, or colluded with a human trafficker?
Within the previous five years, have you ever derived any financial or other benefit from the human trafficking activity of your spouse (including former spouses) or parents, and did you know, or reasonably should have known, that the benefit financial or otherwise who received the result of such human trafficking?
¿Está usted ahora o ha estado involucrado alguna vez en el lavado de dinero como se describe en la sección 1956 o 1957 del Título 18 del Código de los Estados Unidos?
Are you now or have you ever been a knowing aider, abettor, collaborator, conspirator or colluder of others in money laundering?
Your form filing fee is
Evidence
  • I-94
  • Passport
  • 2x2 Passport Photo
  • Church Records or School Records
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