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N-400 Application for Naturalization (United States)

This form is to apply for naturalization in the United States. The form provided here is simply a sample of what the actual Form N-400 looks like.

Department of Homeland Security
U.S Citizenship and Immigration Services

N-400 Application for Naturalization

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Write your USCIS ''A''- number here: A_________________________

For USCIS Use Only

Bar Code

Date Stamp

Remarks


Action Block


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Part 1. Your Name. (The Person Applying for Naturalization)

Print clearly or type your answers using CAPITAL letters. Failure to print clearly may delay your application. Use black ink.

A. Your current legal name.

Family Name (Last Name) ______________________________

Given Name (First Name) ______________________________

Full Middle Name (If applicable) ______________________________

B. Your name exactly as it appears on your Permanent Resident Card.

Family Name (Last Name) ______________________________

Given Name (First Name) ______________________________

Full Middle Name (If applicable) ______________________________

C. If you have ever used other names, provide them below.

Family Name (Last Name) ______________________________

Given Name (First Name) ______________________________

Full Middle Name (If applicable) ______________________________

Family Name (Last Name) ______________________________

Given Name (First Name) ______________________________

Full Middle Name (If applicable) ______________________________

D. Name change (optional)

Please read the Instructions before you decide whether to change your name.

1. Would you like to legally change your name? ____ Yes ____ No

2. If ''Yes," print the new name you would like to use. Do not use initials or abbreviations when writing your new name.

Family Name (Last Name) ______________________________

Given Name (First Name) ______________________________

Full Middle Name ______________________________

Part 2. Information About Your Eligibility. (Check Only One)

I am at least 18 years old AND

A. ____ I have been a Lawful Permanent Resident of the United States for at least five years.

B. ____ I have been a Lawful Permanent Resident of the United States for at least three years, and I have been married to and living with the same U.S. citizen for the last three years, and my spouse has been a U.S. citizen for the last three years.

C. ____ I am applying on the basis of qualifying military service.

D. ____ Other (Please explain) ______________________________

Part 3. Information About You.

A. Social Security Number (if any) ________________________________

B. Date of Birth (mm/dd/yyyy) ________________________________

C. Date You Became a Permanent Resident (mm/dd/yyyy) ________________________________

D. Country of Birth ________________________________

E. Country of Nationality ________________________________

F. Are either of your parents U.S. citizens? (If yes, see Instructions) ____ Yes ____ No

G. What is your current marital status? ____ Single, Never Married ____ Married ____ Widowed

____ Marriage Annulled or Other (Explain) ________________________________

H. Are you requesting a waiver of the English and/or U.S. History and Government requirements based on a disability or impairment and attaching a Form N-648 with your application? ____ Yes ____ No

I. Are you requesting an accommodation to the naturalization process because of a disability or impairment? (See Instructions for some examples of accommodations.) ____ Yes ____ No

If you answered ''Yes," check the box below that applies:

____ I am deaf or hearing impaired and need a sign language interpreter who uses the following language: ________________________________

____ I use a wheelchair.

____ I am blind or sight impaired.

____I will need another type of accommodation. Please explain: ________________________________

Part 4. Addresses and Telephone Numbers.

A. Home Address - Street Number and Name (Do not write a P.O. Box in this space) ________________________________

Apartment Number ________________________________

City ________________________________

County ________________________________

State ________________________________

ZIP Code ________________________________

B. Care of Mailing Address - Street Number and Name (If different from home address) ________________________________

Apartment Number ________________________________

City ________________________________

County ________________________________

State ________________________________

ZIP Code ________________________________

C. Daytime Phone Number (If any) ________________________________

Evening Phone Number (If any) ________________________________

E-mail Address (If any) ________________________________

Part 5. Information for Criminal Records Search.

NOTE: The categories below are those required by the FBI, see instructions for more information.

A. Gender ____ Male ____ Female

B. Height ____ Feet ____ Inches

C. Weight _____ Pounds

D. Are you Hispanic or Latino? ____ Yes ____ No

E. Race (Select one or more.)

____ White ____ Asian ____ Black or African American ____ American Indian or Alaskan Native

____ Native Hawaiian or Other Pacific Islander

F. Hair color

____ Black ____ Brown ____ Blonde ____ Gray ____ White ____ Red ____ Sandy ____ Bald (No Hair)

G. Eye color

____ Brown ____ Blue ____ Green ____ Hazel ____ Gray ____ Black ____ Pink ____ Maroon ____ Other

Part 6. Information About Your Residence and Employment.

A. Where have you lived during the last five years? Begin with where you live now and then list every place you lived for the last five years. If you need more space, use a separate sheet(s) of paper.

Street Number and Name (Current Home Address - Same as Part 4A.)

Apartment Number ________________________________

City ________________________________

County ________________________________

State ________________________________

ZIP Code ________________________________

Dates: (mm/dd/yyyy)

From ________________________________

To Present

Street Number and Name ________________________________

Apartment Number ________________________________

City ________________________________

County ________________________________

State ________________________________

ZIP Code ________________________________

Dates: (mm/dd/yyyy)

From ________________________________

To ________________________________


Street Number and Name ________________________________

Apartment Number ________________________________

City ________________________________

County ________________________________

State ________________________________

ZIP Code ________________________________

Dates: (mm/dd/yyyy)

From ________________________________

To ________________________________


Where have you worked (or, if you were a student, what schools did you attend) during the last five years? Include military service. Begin with your current or latest employer and then list every place you have worked or studied for the last five years. If you need more space, use a separate sheet of paper.

Employer or School Name ________________________________

Employer or School Address (Street, City and State) ________________________________

Dates (mm/dd/yyyy)

From ________________________________

To ________________________________

Your Occupation ________________________________


Employer or School Name ________________________________

Employer or School Address (Street, City and State) ________________________________

Dates (mm/dd/yyyy)

From ________________________________

To ________________________________

Your Occupation ________________________________

Part 7. Time Outside the United States.
(Including Trips to Canada, Mexico and the Caribbean Islands)

A. How many total days did you spend outside of the United States during the past 5 years? _______________ days

B. How many trips of 24 hours or more have you taken outside of the United States during the past 5 years? _________________ trips

C. List below all the trips of 24 hours or more that you have taken outside of the United States since becoming a Lawful Permanent Resident. Begin with your most recent trip. If you need more space, use a separate sheet(s) of paper.

Date you Left the United States (mm/dd/yyyy) ________________________________

Date you Returned to the United States (mm/dd/yyyy) ________________________________

Did Trip Last Six Months or More? ____ Yes ____ No

Countries to Which you Traveled ________________________________

Total Days Out of the United States ________________________________


Date you Left the United States (mm/dd/yyyy) ________________________________

Date you Returned to the United States (mm/dd/yyyy) ________________________________

Did Trip Last Six Months or More? ____ Yes ____ No

Countries to Which you Traveled ________________________________

Total Days Out of the United States ________________________________


Date you Left the United States (mm/dd/yyyy) ________________________________

Date you Returned to the United States (mm/dd/yyyy) ________________________________

Did Trip Last Six Months or More? ____ Yes ____ No

Countries to Which you Traveled ________________________________

Total Days Out of the United States ________________________________

Part 8. Information About Your Marital History.

A. How many times have you been married (including annulled marriages)? _____ If you have never been married, go to Part 9.

B. If you are now married, give the following information about your spouse:

1. Spouse's Family Name (Last Name) _______________________

Given Name (First Name) _______________________

Full Middle Name (If applicable) _______________________

2. Date of Birth (mm/dd/yyyy) _______________________

3. Date of Marriage (mm/dd/yyyy) _______________________

4. Spouse's Social Security # _______________________

5. Home Address - Street Number and Name _______________________

Apartment Number _______________________

City _______________________

State _______________________

Zip Code _______________________

C. Is your spouse a U.S. citizen? ____ Yes ____ No

D. If your spouse is a U.S. citizen, give the following information:

1. When did your spouse become a U.S. citizen?

____ At Birth ____ Other

If ''Other,'' give the following information:

2. Date your spouse became a U.S. citizen ________________________

3. Place your spouse became a U.S. citizen (Please see Instructions) ________________________
City and State

E. If your spouse is not a U.S. citizen, give the following information :

1. Spouse's Country of Citizenship ________________________

2. Spouse's USCIS ''A''- Number (If applicable) A______________________

3. Spouse's Immigration Status

____ Lawful Permanent Resident ________________________

____ Other ________________________

4. Date Marriage Ended (mm/dd/yyyy) ________________________

5. How Marriage Ended ____ Divorce ____ Spouses Died ____ Other ________________________

F. If you were married before, provide the following information about your prior spouse. If you have more than one previous marriage, use a separate sheet(s) of paper to provide the information requested in Questions 1-5 below.

1. Prior Spouse's Family Name (Last Name) ________________________

Given Name (First Name) ________________________

Full Middle Name (If applicable) ________________________

2. Prior Spouse's Immigration Status

____ U.S. Citizen

____ Lawful Permanent Resident

____ Other ________________________

3. Date of Marriage (mm/dd/yyyy) ________________________

4. Date Marriage Ended (mm/dd/yyyy) ________________________

5. How Marriage Ended ____ Divorce ____ Spouses Died ____ Other ________________________

G. How many times has your current spouse been married (including annulled marriages)?

If your spouse has ever been married before, give the following information about your spouse's prior marriage. If your spouse has more than one previous marriage, use a separate sheet(s) of paper to provide the information requested in Questions 1 - 5 below.

1. Prior Spouse's Family Name (Last Name) ________________________

Given Name (First Name) ________________________

Full Middle Name (If applicable) ________________________

2. Prior Spouse's Immigration Status

____ U.S. Citizen

____ Lawful Permanent Resident

____ Other ________________________

3. Date of Marriage (mm/dd/yyyy) ________________________

4. Date Marriage Ended (mm/dd/yyyy) ________________________

5. How Marriage Ended ____ Divorce ____ Spouses Died ____ Other ________________________

Part 9. Information About Your Children.

A. How many sons and daughters have you had? For more information on which sons and daughters you should include and how to complete this section, see the Instructions. _______

B. Provide the following information about all of your sons and daughters. If you need more space, use a separate sheet(s) of paper.

Full Name of Son or Daughter ________________________

Date of Birth (mm/dd/yyyy) ________________________

USCIS "A"-number (if child has one) ________________________

Country of Birth ________________________

Current Address (Street, City, State and Country) ________________________


Full Name of Son or Daughter ________________________

Date of Birth (mm/dd/yyyy) ________________________

USCIS "A"-number (if child has one) ________________________

Country of Birth ________________________

Current Address (Street, City, State and Country) ________________________


Full Name of Son or Daughter ________________________

Date of Birth (mm/dd/yyyy) ________________________

USCIS "A"-number (if child has one) ________________________

Country of Birth ________________________

Current Address (Street, City, State and Country) ________________________

Part 10. Additional Questions.

Please answer Questions 1 through 14. If you answer ''Yes'' to any of these questions, include a written explanation with this form. Your written explanation should (1) explain why your answer was ''Yes'' and (2) provide any additional information that helps to explain your answer.

A. General Questions.

1. Have you ever claimed to be a U.S. citizen (in writing or any other way)? ____ Yes ____ No

2. Have you ever registered to vote in any Federal, state or local election in the United States? ____ Yes ____ No

3. Have you ever voted in any Federal, state or local election in the United States?

4. Since becoming a Lawful Permanent Resident, have you ever failed to file a required Federal, state or local tax return? ____ Yes ____ No

5. Do you owe any Federal, state or local taxes that are overdue? ____ Yes ____ No

6. Do you have any title of nobility in any foreign country? ____ Yes ____ No

7. Have you ever been declared legally incompetent or been confined to a mental institution within the last five years? ____ Yes ____ No

B. Affiliations.

8. a. Have you ever been a member of or associated with any organization, association, fund, foundation, party, club, society or similar group in the United States or in any other place? ____ Yes ____ No

b. If you answered ''Yes,'' list the name of each group below. If you need more space, attach the names of the other group(s) on a separate sheet(s) of paper.

Name of Group

1. ________________________

2. ________________________

3. ________________________

4. ________________________

9. Have you ever been a member of or in any way associated (either directly or indirectly) with:

a. The Communist Party? ____ Yes ____ No

b. Any other totalitarian party? ____ Yes ____ No

c. A terrorist organization? ____ Yes ____ No

10. Have you ever advocated (either directly or indirectly) the overthrow of any government by force or violence? ____ Yes ____ No

11. Have you ever persecuted (either directly or indirectly) any person because of race, religion, national origin, membership in a particular social group or political opinion? ____ Yes ____ No

12. Between March 23, 1933 and May 8, 1945, did you work for or associate in any way (either directly or indirectly) with:

a. The Nazi government of Germany? ____ Yes ____ No

b. Any government in any area (1) occupied by, (2) allied with, or (3) established with the help of the Nazi government of Germany? ____ Yes ____ No

c. Any German, Nazi, or S.S. military unit, paramilitary unit, self-defense unit, vigilante unit, citizen unit, police unit, government agency or office, extermination camp, concentration camp, prisoner of war camp, prison, labor camp or transit camp? ____ Yes ____ No

C. Continuous Residence.

Since becoming a Lawful Permanent Resident of the United States:

13. Have you ever called yourself a ''nonresident'' on a Federal, state or local tax return? ____ Yes ____ No

14. Have you ever failed to file a Federal, state or local tax return because you considered yourself to be a "nonresident"? ____ Yes ____ No

D. Good Moral Character.

For the purposes of this application, 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.

15. Have you ever committed a crime or offense for which you were not arrested? ____ Yes ____ No

16. Have you ever been arrested, cited or detained by any law enforcement officer (including former INS and military officers) for any reason? ____ Yes ____ No

17. Have you ever been charged with committing any crime or offense? ____ Yes ____ No

18. Have you ever been convicted of a crime or offense? ____ Yes ____ No

19. Have you ever been placed in an alternative sentencing or a rehabilitative program (for example: diversion, deferred prosecution, withheld adjudication, deferred adjudication)? ____ Yes ____ No

20. Have you ever received a suspended sentence, been placed on probation or been paroled? ____ Yes ____ No

21. Have you ever been in jail or prison? ____ Yes ____ No

If you answered "Yes" to any of Questions 15 through 21, complete the following table. If you need more space, use a separate sheet (s) of paper to give the same information.

Why were you arrested, cited, detained or charged? ________________________

Date arrested, cited, detained or charged? (mm/dd/yyyy) ________________________

Where were you arrested, cited, detained or charged? (City, State, Country) ________________________

Outcome or disposition of the arrest, citation, detention or charge (No charges filed, charges dismissed, jail, probation, etc.) ________________________

Why were you arrested, cited, detained or charged? ________________________

Date arrested, cited, detained or charged? (mm/dd/yyyy) ________________________

Where were you arrested, cited, detained or charged? (City, State, Country) ________________________

Outcome or disposition of the arrest, citation, detention or charge (No charges filed, charges dismissed, jail, probation, etc.) ________________________

Answer Questions 22 through 33. If you answer "Yes" to any of these questions, attach (1) your written explanation why your answer was ''Yes'' and (2) any additional information or documentation that helps explain your answer.

22. Have you ever:

a. Been a habitual drunkard? ____ Yes ____ No

b. Been a prostitute, or procured anyone for prostitution? ____ Yes ____ No

c. Sold or smuggled controlled substances, illegal drugs or narcotics? ____ Yes ____ No

d. Been married to more than one person at the same time? ____ Yes ____ No

e. Helped anyone enter or try to enter the United States illegally? ____ Yes ____ No

f. Gambled illegally or received income from illegal gambling? ____ Yes ____ No

g. Failed to support your dependents or to pay alimony? ____ Yes ____ No

23. Have you ever given false or misleading information to any U.S. government official while applying for any immigration benefit or to prevent deportation, exclusion or removal? ____ Yes ____ No

24. Have you ever lied to any U.S. government official to gain entry or admission into the United States? ____ Yes ____ No

E. Removal, Exclusion and Deportation Proceedings.

25. Are removal, exclusion, rescission or deportation proceedings pending against you? ____ Yes ____ No

26. Have you ever been removed, excluded or deported from the United States? ____ Yes ____ No

27. Have you ever been ordered to be removed, excluded or deported from the United States? ____ Yes ____ No

28. Have you ever applied for any kind of relief from removal, exclusion or deportation? ____ Yes ____ No

F. Military Service.

29. Have you ever served in the U.S. Armed Forces? ____ Yes ____ No

30. Have you ever left the United States to avoid being drafted into the U.S. Armed Forces? ____ Yes ____ No

31. Have you ever applied for any kind of exemption from military service in the U.S. Armed Forces? ____ Yes ____ No

32. Have you ever deserted from the U.S. Armed Forces? ____ Yes ____ No

G. Selective Service Registration.

33. Are you a male who lived in the United States at any time between your 18th and 26th birthdays in any status except as a lawful nonimmigrant? ____ Yes ____ No

If you answered "NO," go on to question 34.

If you answered "YES," provide the information below.

If you answered "YES," but you did not register with the Selective Service System and are still under 26 years of age, you must register before you apply for naturalization, so that you can complete the information below:

Date Registered (mm/dd/yyyy) ________________________

Selective Service Number ________________________

If you answered "YES," but you did not register with the Selective Service and you are now 26 years old or older, attach a statement explaining why you did not register.

H. Oath Requirements. (See Part 14 for the Text of the Oath)

Answer Questions 34 through 39. If you answer ''No'' to any of these questions, attach (1) your written explanation why the answer was ''No'' and (2) any additional information or documentation that helps to explain your answer.

34. Do you support the Constitution and form of government of the United States? ____ Yes ____ No

35. Do you understand the full Oath of Allegiance to the United States? ____ Yes ____ No

36. Are you willing to take the full Oath of Allegiance to the United States? ____ Yes ____ No

37. If the law requires it, are you willing to bear arms on behalf of the United States? ____ Yes ____ No

38. If the law requires it, are you willing to perform noncombatant services in the U.S. Armed Forces? ____ Yes ____ No

39. If the law requires it, are you willing to perform work of national importance under civilian direction? ____ Yes ____ No

Part 11. Your Signature.

I certify, under penalty of perjury under the laws of the United States of America, that this application, and the evidence submitted with it, are all true and correct. I authorize the release of any information that USCIS needs to determine my eligibility for naturalization.

Your Signature ________________________

Date (mm/dd/yyyy) ________________________

Part 12. Signature of Person Who Prepared This Application for You. (If Applicable)

I declare under penalty of perjury that I prepared this application at the request of the above person. The answers provided are based on information of which I have personal knowledge and/or were provided to me by the above named person in response to the exact questions contained on this form.

Preparer's Printed Name ________________________

Preparer's Signature ________________________

Date (mm/dd/yyyy) ________________________

Preparer's Firm or Organization Name (If applicable) ________________________

Preparer's Daytime Phone Number ________________________

Preparer's Address - Street Number and Name ________________________

City ________________________

State ________________________

Zip Code ________________________

NOTE: Do not complete Parts 13 and 14 until a USCIS Officer instructs you to do so.

Part 13. Signature at Interview.

I swear (affirm) and certify under penalty of perjury under the laws of the United States of America that I know that the contents of this application for naturalization subscribed by me,

including corrections numbered 1 through _____ and the evidence submitted by me

numbered pages 1 through _____, are true and correct to the best of my knowledge and belief.

Subscribed to and sworn to (affirmed) before me ________________________ (Officer's Printed Name or Stamp)

Date (mm/dd/yyyy) ________________________

Complete Signature of Applicant ________________________

Officer's Signature ________________________

Part 14. Oath of Allegiance.

If your application is approved, you will be scheduled for a public oath ceremony at which time you will be required to take the following oath of allegiance immediately prior to becoming a naturalized citizen. By signing, you acknowledge your willingness and ability to take this oath:

I hereby declare, on oath, that I absolutely and entirely renounce and abjure all allegiance and fidelity to any foreign prince, potentate, state, or sovereignty, of whom or which I have heretofore been a subject or citizen;

that I will support and defend the Constitution and laws of the United States of America against all enemies, foreign and domestic;

that I will bear true faith and allegiance to the same;

that I will bear arms on behalf of the United States when required by the law;

that I will perform noncombatant service in the Armed Forces of the United States when required by the law;

that I will perform work of national importance under civilian direction when required by the law; and

that I take this obligation freely, without any mental reservation or purpose of evasion; so help me God.

Printed Name of Applicant ________________________

Complete Signature of Applicant ________________________

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