Naturalization Questionnaire

INFORMATION ABOUT YOU

Your Current Legal Name

First

Middle

Last

Your Name as It Appears on Your Green Card

First

Middle

Last

Other Names Used 1

First

Middle

Last

Other Names Used 2

First

Last

Do you want to legally change your name?

Yes
No

New Name You Wish to Use

First

Middle

Last

Social Security Number (SSN)

Sex

Date of Birth

Place of Birth (City / State / Country)

Country of Citizenship or Nationality

Phone

Email

Alien Number (USCIS Number or A#)

Date You Became a Permanent Resident

Ethnicity

Race (Select All That Apply)

Height (Feet - Inches)

Weight in Pounds

Eye Color

Hair Color

ADDRESS HISTORY FOR THE PAST 5 YEARS

Current Address

Address Line 1

Address Line 2

City

State

Zip Code

Date From

Date To

Prior Address 1

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date From

Date To

Prior Address 2

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date From

Date To

Prior Address 3

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date From

Date To

EMPLOYMENT/SCHOOL HISTORY FOR THE PAST 5 YEARS

Employer or School 1 (Current or Most Recent)

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Job Title

Start Date

End Date

Employer or School 2

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Job Title

Start Date

End Date

Employer or School 3

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Job Title

Start Date

End Date

Most Recent Employer Outside of The US If Not Listed Above

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Job Title

Start Date

End Date

INFORMATION ABOUT YOUR PARENTS

Are either of your parents a US citizen?

Yes
No

Were your parents married before your 18th birthday?

Yes
No

Is your mother a US citizen?

Yes
No

Mother's Name

First

Middle

Last

Place of Birth (City & Country)

Date of Birth

Date mother became a US citizen

A-Number

Is your father a US citizen?

Yes
No

Father's Name

First

Middle

Last

Place of Birth (City & Country)

Date of Birth

Date father became a US citizen

A-Number

TIME SPENT OUTSIDE OF THE UNITED STATES

How many total days (24 hours or longer) did you spend outside the US during the last five years?

How many trips (24 hours or longer) did you take outside the US during the last five years?

List All Trips Outside of the US for the Past Five Years (Date Left / Date Returned / Countries Visited / Total Days Per Trip)

MARITAL HISTORY

What is Your Current Marital Status?

Is your spouse a current member of the US armed forces?

Yes
No

How many times have you been married?

Current Spouse's Name

First

Middle

Last

Current Spouse's Former Name, if any

First

Middle

Last

Current Spouse's Date of Birth

Date of Marriage

Current Spouse's Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Current Spouse's Current Employer

Is your current spouse a US citizen?

Yes
No

When did your current spouse become a US citizen?

At birth
Other

Current Spouse's Country of Citizenship or Nationality

Current Spouse's Alien Number (USCIS Number or A#)

Current Spouse's Immigration Status

Was your current spouse previously married?

Yes
No

Current Spouse's Prior Spouse's Name 1

First

Middle

Last

Current Spouse's Prior Spouse's Immigration Status

Current Spouse's Prior Spouse's Date of Birth

Current Spouse's Prior Spouse's Place of Birth (City / State / Country)

Current Spouse's Prior Spouse's Country of Citizenship

Current Spouse's Prior Spouse's Date of Marriage with Prior Spouse

Date Marriage Ended Between Current Spouse' with Prior Spouse

How Current Spouse's Previous Marriage Ended

Were you previously married?

Yes
No

Prior Spouse's Name

First

Middle

Last

Prior Spouse's Immigration Status

Prior Spouse's Date of Birth

Prior Spouse's Country of Birth

Prior Spouse's Country of Citizenship

Date of Marriage With Prior Spouse

Date Marriage Ended with Prior Spouse

How Marriage Ended with Prior Spouse

INFORMATION ABOUT YOUR CHILDREN

Child 1 Name

First

Middle

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Alien Number (USCIS Number or A#)

Date of Birth

Country of Birth

What is your child's relationship to you?

Child 2 Name

First

Middle

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Alien Number (USCIS Number or A#)

Date of Birth

Country of Birth

What is your child's relationship to you?

Child 3 Name

First

Middle

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Alien Number (USCIS Number or A#)

Date of Birth

Country of Birth

What is your child's relationship to you?

Child 4 Name

First

Middle

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Alien Number (USCIS Number or A#)

Date of Birth

Country of Birth

What is your child's relationship to you?

BACKGROUND QUESTIONS

Have you ever claimed to be a US citizen?

Have you ever registered to vote in any Federal, state, or local election in the United States?

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

Do you now have, or did you ever have, a hereditary title or an order of nobility in any foreign country?

Are you willing to give up such a title at your naturalization ceremony?

Have you ever been declared legally incompetent or been confined to a mental institution?

Do you owe any overdue Federal, state, or local taxes?

Have you ever not filed a Federal, state, or local tax return since you became a lawful permanent resident?

Did you consider yourself to be a non-US resident?

Have you called yourself a non-US resident on a Federal, state, or local tax return since you became a lawful permanent resident?

List the name(s) of organization(s), location(s), dates of membership, from and to, and the nature of any organization(s) you have ever been involved in or associated with.

Have you ever been a member of, or in any way associated with the Communist party?

Have you ever been a member of, or in any way associated with any other totalitarian party?

Have you ever been a member of, or in any way associated with a terrorist organization?

Have you ever advocated the overthrow of any government by force or violence?

Have you ever persecuted any person because of race, religion, national origin, membership in a particular social group, or political opinion?

Between March 23, 1933 and May 8, 1945, did you work for or associate in any way with the Nazi government of Germany?

Between March 23, 1933 and May 8, 1945, did you work for or associate in any way with any government in any area occupied by, allied with, or established with the help of the Nazi government of Germany?

Between March 23, 1933 and May 8, 1945, did you work for or associate in any way with any German, Nazi, or SS military unit

Were you ever involved in any way with genocide?

Were you ever involved in any way with killing, or trying to kill, someone?

Were you ever involved in any way with badly hurting, or trying to hurt, a person on purpose?

Were you ever involved in any way with forcing, or trying to force, someone to have any kind of sexual contact or relation?

Were you ever involved in any way with not letting someone practice his or her religion?

Were you ever involved in any way with torture?

Were you ever a member of, or did you ever serve in, help, or otherwise participate in a military unit, paramilitary unit, police unit, self-defense unit, vigilante unit, rebel group, guerilla group, militia, or insurgent organization?

Were you ever a worker, volunteer, or soldier, or did you otherwise ever serve in a prison or jail, prison camp, detention facility, labor camp, or any other place where people were forced to stay?

Were you ever a part of any group, or did you ever help any group, unit, or organization that used a weapon against any person or threatened to do so?

When you were a part of this group, or when you helped this group, did you ever use a weapon against another person?

When you were a part of this group, or when you helped this group, did you ever tell another person that you would use a weapon against another person?

Did you ever sell, give, or provide weapons to any person, or help another person sell, give, or provide weapons to any person?

Did you know that this person was going to use the weapons against another person?

Did you know that this person was going to sell or give the weapons to someone who was going to use them against another person?

Did you ever receive any type of military, paramilitary, or weapons training?

Did you ever use any person under 15 years of age to do anything that helped or supported people in combat?

Have you ever committed, assisted in committing, or attempted to commit, a crime or offense for which you were not arrested?

Have you ever been arrested, cited, or detained by any law enforcement officer, including any immigration official or any official of the US armed forces for any reason?

Have you ever been charged with committing, attempting to commit, or assisting in committing a crime or offense?

Have you ever been convicted of a crime or offense?

Have you ever been placed in an alternative sentencing or rehabilitation program?

Have you ever received a suspended sentence, been placed on probation, or been paroled?

Have you completed the probation or parole?

Have you ever been in jail or prison?

How long were you in jail or prison? (Years / Months / Days)

List the reasons, dates, and locations, and the outcome of each incident.

Have you ever been a habitual drunkard?

Have you ever been a prostitute, or procured anyone for prostitution?

Have you ever sold or smuggled controlled substances, illegal drugs, or narcotics?

Have you ever been married to more than one person at the same time?

Have you ever married someone in order to obtain an immigration benefit?

Have you ever helped anyone to enter, or try to enter, the United States illegally?

Have you ever gambled illegally or received income from illegal gambling?

Have you ever failed to support your dependents or to pay alimony?

Have you ever made any misrepresentations to obtain any public benefit in the United States?

Have you ever given any US Government officials any information or documentation that was false, fraudulent, or misleading?

Have you ever been removed, excluded, or deported from the United States?

Have you ever been ordered removed, excluded, or deported from the United States?

Have you ever been placed in removal, exclusion, rescission, or deportation proceedings?

Are removal, exclusion, rescission, or deportation proceedings currently pending against you?

Have you ever served in the US armed forces?

Are you currently a member of the US armed forces?

Are you scheduled to deploy to overseas within the next three months?

Are you currently stationed overseas?

Have you ever been court-martialed, administratively separated, or disciplined, or have you received an other than honorable discharge while in the US armed forces?

Have you ever been discharged from training or service in the US armed forces because you were an alien?

Have you ever left the United States to avoid being drafted in the US armed forces?

Have you ever applied for any kind of exemption from military service in the US armed forces?

Have you ever deserted from the US armed forces?

Are you a male who lived in the US at any time between your 18th and 26th birthdays? (This does not include living in the US as a lawful nonimmigrant.)

When did you register for the Selective Service?

Selective Service Registration Number

Do you support the Constitution and form of Government of the United States?

Do you understand the full Oath of Allegiance to the United States?

Are you willing to take the full Oath of Allegiance to the United States?

If the law requires it, are you willing to bear arms on behalf of the United States?

If the law requires it, are you willing to perform noncombatant services in the US armed forces?

If the law requires it, are you willing to perform work of national importance under civilian direction?

Enter the Information of the Person Submitting This Questionnaire

Name *

Email *

Naturalization Questionnaire

For US Citizenship

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