I-360, Petition for Amerasian, Widow(er) or Special Immigrant (United States)
This form is for an immigration bond in the United States. The form provided here is simply a sample of what the actual Form I-352 looks like.
Department of Homeland Security
U.S. Citizenship and Immigration Services
I-360, Petition for Amerasian, Widow(er) or Special Immigrant
START HERE - Please type or print in black ink.
Part 1. Information about person or organization filing this petition.
(Individuals should use the top name line; organizations should use the second line.) If you are a self-petitioning spouse or child and do not want USCIS to send notices about this petition to your home, you may show an alternate mailing address here. If you are filing for yourself and do not want to use an alternate mailing address, skip to part 2.
Family Name _______________________________
Given Name _______________________________
Middle Name _______________________________
Company or Organization Name _______________________________
Address - C/O _______________________________
Street Number and Name _______________________________
Apt # ______________
City _______________________________
State or Province _______________________________
Country _______________________________
Zip/Postal Code _______________________________
U.S. Social Security # _______________________________
A # _______________________________
IRS Tax # (if any) _______________________________
Part 2. Classification Requested (check one):
a. ____ Amerasian
b. ____ Widow(er) of a U.S. citizen who died within the past two (2) years
c. ____ Special Immigrant Juvenile
d. ____ Special Immigrant Religious Worker
e. ____ Special Immigrant based on employment with the Panama Canal Company, Canal Zone Government or U.S. Government in the Canal Zone
f. ____ Special Immigrant Physician
g. ____ Special Immigrant International Organization Employee or family member
h. ____ Special Immigrant Armed Forces Member
i. ____ Self-Petitioning Spouse of Abusive U.S. Citizen or Lawful Permanent Resident
j. ____ Self-Petitioning Child of Abusive U.S. Citizen or Lawful Permanent Resident
k. ____ Other, explain: _______________________________
Part 3. Information about the person this petition is for.
Family Name ______________________________
Given Name ______________________________
Middle Name ______________________________,
Address - C/O _______________________________
Street Number and Name _______________________________
Apt # ______________
City _______________________________
State or Province _______________________________
Country _______________________________
Zip/Postal Code _______________________________
Date of Birth (mm/dd/yyyy) _______________________________
Country of Birth _______________________________
U.S. Social Security # _______________________________
A # (if any) _______________________________
Marital Status: ____ Single ____ Married ____ Divorced ____ Widowed
Complete the items below if this person is in the United States:
Date of Arrival (mm/dd/yyyy)______________________________
Current Nonimmigrant Status ______________________________
I-94 #______________________________
Expires on (mm/dd/yyyy) ______________________________
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For USCIS Use Only
Returned
Resubmitted
Reloc Sent
Reloc Rec'd
____ Petitioner/Applicant Interviewed
____ Beneficiary Interviewed
Receipt
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____ I-485 Filed Concurrently
____ Bene "A" File Reviewed
Classification ______________________________
Consulate ______________________________
Priority Date ______________________________
Remarks ______________________________
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Action Block
To Be Completed by
____ Attorney or Representative, if any
Fill in box if G-28 is attached to represent the applicant
VOLAG # ______________________________
ATTY State License # ______________________________
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Part 4. Processing Information.
Below give information on U.S. Consulate you want notified if this petition is approved and if any requested adjustment of status cannot be granted.
American Consulate: City ______________________________
Country ______________________________
If you gave a United States address in Part 3, print the person's foreign address below. If his or her native alphabet does not use Roman letters, print his or her name and foreign address in the native alphabet.
Name ______________________________
Address ______________________________
Gender of the person this petition is for. ____ Male ____ Female
Are you filing any other petitions or applications with this one? ____ No ____ Yes (How many? _______)
Is the person this petition is for in deportation or removal proceedings? ____ No ____ Yes (Explain on a separate sheet of paper)
Has the person this petition is for ever worked in the U.S. without permission? ____ No ____ Yes (Explain on a separate sheet of paper)
Is an application for adjustment of status attached to this petition? ____ No ____ Yes
Part 5. Complete only if filing for an Amerasian.
Section A. Information about the mother of the Amerasian
Family Name _______________________________
Given Name _______________________________
Middle Name _______________________________
Living? ____ No (Give date of death ____________) ____ Yes (complete address line below) ____ Unknown (attach a full explanation)
Address _______________________________
Section B. Information about the father of the Amerasian:
If possible, attach a notarized statement from the father regarding parentage. Explain on separate paper any question you cannot fully answer in the space provided on this form.
Family Name _______________________________
Given Name _______________________________
Middle Name _______________________________
Date of Birth (mm/dd/yyyy) _______________________________
Country of Birth _______________________________
Living? ____ No (Give date of death ____________) ____ Yes (complete address line below) ____ Unknown (attach a full explanation)
Home Address _______________________________
Home Phone # _______________________________
Work Phone # _______________________________
At the time the Amerasian was conceived:
The father was in the military (indicate branch of service below - and give service number here): _______________________________
____ Army ____ Air Force ____ Navy ____ Marine Corps ____ Coast Guard
____ The father was a civilian employed abroad. Attach a list of names and addresses of organizations which employed him at that time.
____ The father was not in the military, and was not a civilian employed abroad. (Attach a full explanation of the circumstances.)
Part 6. Complete only if filing for a Special Immigrant Juvenile Court Dependent.
Section A. Information about the Juvenile
List any other names used.
Answer the following questions regarding the person this petition is for. If you answer "No," explain on a separate sheet of paper.
Is he or she still dependent upon the juvenile court or still legally committed to or under the custody of an agency
or department of a state? ____ No ____ Yes
Does he or she continue to be eligible for long term foster care? ____ No ____ Yes
Part 7. Complete only if filing as a Widow/Widower, a Self-petitioning Spouse of an Abuser, or as a Self-petitioning Child of an Abuser.
Section A. Information about the U.S. citizen husband or wife who died or about the U.S. citizen or lawful permanent resident abuser.
Family Name _______________________________
Given Name _______________________________
Middle Name _______________________________
Date of Birth (mm/dd/yyyy) _______________________________
Country of Birth _______________________________
Date of Death (mm/dd/yyyy) _______________________________
He or she is now, or was at time of death a (check one):
____ U.S. citizen born in the United States.
____ U.S. citizen born abroad to U.S. citizen parents.
____ U.S. citizen through Naturalization (Show A #) _______________________________
____ U.S. lawful permanent resident (Show A #) _______________________________
____ Other, explain _______________________________
Section B. Additional Information about you.
How many times have you been married? _______________________________
How many times was the person in Section A married? _______________________________
Give the date and place where you and the person in Section A were married. (If you are a self-petitioning child, write: "N/A") _______________________________
When did you live with the person named in Section A?
From (Month/Year) _______________________________
until (Month/Year) _______________________________
If you are filing as a widow/widower, were you legally separated at the time of the U.S citizens's death? ____ No ____ Yes, (attach explanation).
Give the last address at which you lived together with the person named in Section A, and show the last date that you lived together with that person at that address: _______________________________
If you are filing as a self-petitioning spouse, have any of your children filed separate self-petitions? ____ No ____ Yes (show child(ren)'s full names): _______________________________
Part 8. Information about the spouse and children of the person this petition is for.
A widow/widower or a self-petitioning spouse of an abusive citizen or lawful permanent resident should also list the children of the deceased spouse or of the abuser.
A.
Family Name _______________________________
Given Name _______________________________
Middle Name _______________________________
Date of Birth (mm/dd/yyyy) _______________________________
Country of Birth _______________________________
Relationship
____ Spouse
____ Child
A # _______________________________
B.
Family Name _______________________________
Given Name _______________________________
Middle Name _______________________________
Date of Birth (mm/dd/yyyy) _______________________________
Country of Birth _______________________________
Relationship
____ Child
A # _______________________________
C.
Family Name _______________________________
Given Name _______________________________
Middle Name _______________________________
Date of Birth (mm/dd/yyyy) _______________________________
Country of Birth _______________________________
Relationship
____ Child
A # _______________________________
Part 9. Signature. Read the information on penalties in the instructions before completing this part. If you are going to file this petition at a USCIS office in the United States, sign below. If you are going to file it at a U.S. consulate or USCIS office overseas, sign in front of a USCIS or consular official.
I certify, or, if outside the United States, I swear or affirm, under penalty of perjury under the laws of the United States of America, that this petition and the evidence submitted with it is all true and correct. If filing this on behalf at an organization, I certify that I am empowered to do so by that organization. I authorize the release of any information from my records, or from the petitioning organization's records, that the U.S. Citizenship and Immigration Services needs to determine eligibility for the benefit being sought.
Signature _______________________________
Date _______________________________
Signature of USCIS or Consular Official _______________________________
Print Name _______________________________
Date _______________________________
NOTE: If you do not completely fill out this petition or fail to submit required documents listed in the instructions, the person(s) filed for may not be found eligible for a requested benefit and the petition may be denied.
Part 10. Signature of person preparing form, if other than above. (Sign below.)
I declare that I prepared this application at the request of the above person and it is based on all information of which I have knowledge.
Signature _______________________________
Print Your Name _______________________________
Date _______________________________
Firm Name and Address _______________________________