Form I-360 Edition 04/01/24 Page 1 of 19

For USCIS Use Only

Petition for Amerasian, Widow(er), or Special Immigrant 

Department of Homeland Security 

U.S. Citizenship and Immigration Services

USCIS 

Form I-360 

OMB No. 1615-0020 

Expires 02/28/2026

► START HERE - Type or print in black ink.

Remarks:

Action Block

Sent

Received

Relocated

Fee Stamp

Resubmitted

Petitioner/Applicant 

Interviewed

Interviewed Beneficiary 

Interviewed

Bene "A" File Reviewed

I-485 Filed Concurrently

Returned

Priority Date

Consulate

Classification

Part 1. Information About Person or Organization Filing This Petition 

Family Name (Last Name)

Your Full Name

NOTE: 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 Address

Given Name (First Name) Middle Name 

City or Town State ZIP Code

Street Number and Name Apt. Ste. Flr. Number

Province Postal Code Country

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)

► A1.

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 Edition 04/01/24 Page 2 of 19

Alternate and/or Safe Mailing Address

City or Town State ZIP Code

In Care Of Name (if any)

Street Number and Name Apt. Ste. Flr. Number

Province Postal Code Country

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)

Amerasian

Select only one box.

Special Immigrant Religious Worker 

Special Immigrant Juvenile

Widow(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 

Member

Special Immigrant Armed Forces Member

Special 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 translator

Self-Petitioning Child of Abusive U.S. citizen or Lawful Permanent Resident

Special Immigrant Iraq National who was employed by or on behalf of the U.S. Government

Broadcasters

P. Other

Special 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 Edition 04/01/24 Page 3 of 19

Part 3. Information About the Person for Whom This Petition Is Being Filed

Family Name (Last Name)

Your Full Name

Given Name (First Name) Middle Name

Mailing Address

Other Information

Date of Birth (mm/dd/yyyy)

►

U.S. Social Security Number (if any)

Country of Birth

► AA-Number (if any)

4.

5. 6.

8.

10.

9.

11.

13.

15.

3.

7. Marital Status Single Married Divorced Widowed

Complete 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 Document Expiration Date for Passport or Travel Document

Date of Last Arrival (mm/dd/yyyy) Form I-94 Number or I-95 Crewman's Landing Permit

Date current status expired, or will expire, as shown on 

Passport Number Travel 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 Information

City or Town

U.S. Consulate

1.

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.

B. Country

City or Town State ZIP Code

In Care Of Name (if any)

Street Number and Name Apt. Ste. Flr. Number

Province Postal Code Country

12.

14.
Form I-360 Edition 04/01/24 Page 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 Name Apt. Ste. Flr. Number

Postal Code Country

City 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

No

Your Full Name

B. Mailing Address

A.

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 Filed

A-Number (if any)

► ACountry of Birth

Relationship

Date of Birth (mm/dd/yyyy)

Given Name (First Name) Middle Name 

Person 1

Family Name (Last Name)

Spouse Child

2.

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.

1. If you are filing as a self-petitioning spouse, have any of your children filed separate self-petitions? Yes No

Province
Form I-360 Edition 04/01/24 Page 5 of 19

A-Number (if any)

► ARelationship

Person 2

Child

3.

Part 5. Information About the Spouse and Children of the Beneficiary (continued)

4. Person 3

5. Person 4

6. Person 5

7. Person 6

Country of Birth

Family Name (Last Name) Given Name (First Name) Middle Name 

A-Number (if any)

► ARelationship

Child

Country of Birth

Family Name (Last Name) Given Name (First Name) Middle Name 

A-Number (if any)

► ARelationshipChild

Country of Birth

Family Name (Last Name) Given Name (First Name) Middle Name 

A-Number (if any)

► ARelationshipChild

Country of Birth

Family Name (Last Name) Given Name (First Name) Middle Name 

A-Number (if any)

► ARelationshipChild

Country of Birth

Family Name (Last Name) Given Name (First Name) Middle 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 Edition 04/01/24 Page 6 of 19

Part 5. Information About the Spouse and Children of the Beneficiary (continued)

8. Person 7

9. Person 8

10. Person 9

Part 6. Complete Only If Filing for an Amerasian

Information About the Mother of the Amerasian 

Family Name (Last Name)

Mother's Full Name

Given Name (First Name) Middle Name 

1.

2. A. Is the mother still alive? Unknown

B. If you answered "Yes" to Item A. in Item Number 2., provide her address below. 

City or Town State ZIP Code

In Care Of Name (if any)

Street Number and Name Apt. Ste. Flr. Number

Province Postal Code Country

A-Number (if any)

► ARelationshipChild

Country of Birth

Family Name (Last Name) Given Name (First Name) Middle Name 

A-Number (if any)

► ARelationshipChild

Country of Birth

Family Name (Last Name) Given Name (First Name) Middle Name 

A-Number (if any)

► ARelationshipChild

Country of Birth

Family Name (Last Name) Given Name (First Name) Middle Name 

Date of Birth (mm/dd/yyyy)

Date of Birth (mm/dd/yyyy)

Date of Birth (mm/dd/yyyy)

Yes No
Form I-360 Edition 04/01/24 Page 7 of 19

C. If you answered "No" to Item A. in Item Number 2., provide her date of death (mm/dd/yyyy).

Part 6. Complete Only If Filing for an Amerasian (continued)

Information About the Father of the Amerasian 

Date of Birth (mm/dd/yyyy) 5. Country of Birth

If possible, attach a notarized statement from the father regarding parentage. If there is a question you cannot fully answer in the 

space provided on this petition, use the space provided in Part 15. Additional Information.

Family Name (Last Name)

Father's Full Name

Given Name (First Name) Middle Name 

3.

4.

6. A. Is the father still alive?

B.

C.

D. E.

If you answered "Yes" to Item A. in Item Number 6., provide his address below.

Unknown

If you answered "No" to Item A. in Item Number 6., provide his date of death (mm/dd/yyyy).

Daytime Telephone Number (if any) Work Telephone Number (if any)

At the time the Amerasian was conceived:

7. A.

B.

C.

The father was in the military (indicate branch of service below). 

Provide the father's service number:

Army Air Force Navy Marine Corps Coast Guard

The father was not in the military and was not a civilian employed abroad. (Attach a full explanation of the 

circumstances.)

Family Name (Last Name)

Full Name of U.S. Citizen Husband or Wife Who Died

Given Name (First Name) Middle Name 

1.

Part 7. Complete Only If Filing as a Widow/Widower

2. Date of Birth (mm/dd/yyyy) 3. Country of Birth 4. Date of Death (mm/dd/yyyy)

City or Town State ZIP Code

In Care Of Name (if any)

Street Number and Name Apt. Ste. Flr. Number

Province Postal Code Country

Yes No
Form I-360 Edition 04/01/24 Page 8 of 19

At time of death, your spouse was a (Select only one):

U.S. citizen born abroad to U.S. citizen parents

A. U.S. citizen born in the United States

B.

Part 7. Complete Only If Filing as a Widow/Widower (continued)

D. Other (Explain)

U.S. citizen through naturalization

Provide A-Number (if any)

C.

(1) ► AWhen did you and your spouse get married (mm/dd/yyyy)?

Did you remarry after the death of your spouse?

If you are filing as a widow(er), were you legally separated at the time of the U.S. citizen's death?

NOTE: If you answered "Yes" to Item Number 10., provide an explanation in the space provided in Part 15. Additional 

Information.

10.

If you answered "Yes" to Item A. in Item Number 9., provide the date that you remarried (mm/dd/yyyy).

9.

Where did you and your spouse get married?

8.

6.

7.

No

Yes No

Yes 

How many times was your spouse married?

How many times have you been married?

A.

A.

B.

B.

Answer the following questions regarding the person for whom the petition is being filed. If you answer "No" to Item A. in Item 

Number 2., provide an explanation in the space provided in Part 15. Additional Information.

Family Name (Last Name) Given Name (First Name) Middle Name

Part 8. Complete Only If Filing for a Special Immigrant Juvenile 

Information About the Juvenile

List any other names used:

A. Family Name (Last Name) Given Name (First Name) Middle Name 

B.

Have you been declared dependent on a juvenile court in the United States OR has a juvenile court 

legally committed you to, or placed you under the custody of, an agency, department of a state, or an 

individual or entity?

Provide the name of the state agency, department, or court-appointed organization or individual with which you are placed 

below. 

A. Yes No

B.

C.

2.

5.

1.

Are you currently under the jurisdiction of the juvenile court that made your placement or custody 

determination identified in Item B. in Item Number 2. above? 

Yes No
Form I-360 Edition 04/01/24 Page 9 of 19

If you selected "one" in Item A. in Item Number 4., provide the name of that parent below.

Has it been determined in judicial or administrative proceedings that it would not be in your best interest 

to be returned to your or your parent's country of citizenship or nationality or last habitual residence?

A juvenile court has determined that reunification with 

3. A. If you answered "Yes" to Item C. in Item Number 2. above, are you currently residing in your 

court-ordered placement? 

If you answered "No" to Item C. in Item Number 2. above, select your reason below.

Yes 

If you answered "Yes" to Item A. in Item Number 6., and you are in HHS custody, did the juvenile 

court order determine or alter your custody status or placement?

Yes No

Are you currently or were you previously in the custody of the U.S. Department of Health and No

Human Services (HHS)?

4. one or both of my parents is not viable due to:

6. A.

B.

5. Yes 

Yes No

No

Abuse

You were adopted or placed in a permanent guardianship or another permanent living arrangement (other than 

reunification with the abusive parents).

Neglect Abandonment

Similar basis under state law (specify): 

Part 8. Complete Only If Filing for a Special Immigrant Juvenile (continued)

A.

B.

B.

Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition

Prospective Employer Attestation

Provide the following information about the prospective employer.

A. Number of members of the prospective employer's organization

B. Number of employees working at the same location where the beneficiary will be employed

C. Number of aliens holding special immigrant or nonimmigrant religious worker status who are currently 

employed or were employed within the past five years 

D. Number of Special Immigrant Religious Worker (Form I-360) and Nonimmigrant Religious Worker 

(Form I-129) petitions submitted by the prospective employer within the past five years

E. Number of Special Immigrant Religious Worker (Form I-360) petitions submitted by the beneficiary 

during the last five years

2. Has the beneficiary or have any of the beneficiary's dependent family members previously been admitted 

to the United States for a period of stay in the Religious Worker (R) classification during the last five 

years?

Yes No

If you answered "Yes" to Item Number 2., provide the beneficiary's and any dependent family member's prior periods of stay in 

the R classification in the United States during the last five years. Be sure to provide only those periods when the beneficiary 

and/or family members were actually in the United States in the R classification. Provide the beneficiary's information in Item 

Number 3. below. For dependent family members, use the space provided in Part 15. Additional Information.

NOTE: Submit photocopies of Form I-94 Arrival-Departure Record, Form I-797 (Notice of Action), and/or other USCIS 

documents identifying these periods of stay in the R classification. If you need extra space to complete this section, use the 

space provided in Part 15. Additional Information.

1.

Other. (If you selected "Other," provide an explanation in the space provided in Part 15. Additional Information.)

You aged-out of the juvenile court's jurisdiction and the order was terminated based on age. 
Form I-360 Edition 04/01/24 Page 10 of 19

Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition (continued)

Position

Summary of the Type of Responsibilities for That Position 

Provide a summary of the type of responsibilities of those employees, other than the beneficiary, who work at the same location 

where the beneficiary will be employed. If you need extra space to complete this section, use the space provided in Part 15. 

Additional Information.

4.

Describe the relationship, if any, between the religious organization in the United States and the organization abroad of which 

the beneficiary is a member.

5.

6. Provide the following information about the prospective employment. If you need extra space to complete this section, use the 

space provided in Part 15. Additional Information.

A. Title of position offered

C. Detailed description of the beneficiary's proposed daily duties

D. Description of the beneficiary's qualifications for the position offered

E. Description of the proposed salaried and/or non-salaried compensation

F. Provide the specific addresses or locations where the beneficiary will be working

City or Town State ZIP Code

Company Name

Street Number and Name Apt. Ste. Flr. Number

Province Postal Code Country

B. The beneficiary will be working (select one of the following): 

As a minister 

In a religious vocation

In a religious occupation

Period of Stay

From (mm/dd/yyyy)

3. Beneficiary

Family Name (Last Name) Given Name (First Name) Middle Name 

To (mm/dd/yyyy)
Form I-360 Edition 04/01/24 Page 11 of 19

Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition (continued)

The prospective employer is a bona fide non-profit religious organization or a bona fide organization that 

is affiliated with the religious denomination and is tax exempt as described in section 501(c)(3) of the 

Internal Revenue Code of 1986, subsequent amendment, or equivalent sections of prior enactments of the 

Internal Revenue Code. If the prospective employer is affiliated with the religious denomination, 

complete the Religious Denomination Certification included in this petition.

7. Yes No

If you answered "Yes," select the applicable box and attach the appropriate documentation to the petition.

A currently valid determination letter from the Internal Revenue Service (IRS) establishing that the organization is a 

tax-exempt organization; 

If you are claiming that the prospective employer is a bona fide organization that is affiliated with the religious 

denomination, provide the following:

A currently valid determination letter from the IRS establishing that the organization is recognized as tax-exempt 

under a group tax exemption; or

A.

B.

C.

(1)

Documentation that establishes the religious nature and purpose of the organization, such as a copy of the 

organizing instrument of the organization that specifies the purposes of the organization;

(3)

A completed religious denomination certification, signed and dated, certifying that the petitioning 

organization is affiliated with the religious denomination.

(4)

Organizational literature, such as books, articles, brochures, calendars, flyers, and other literature describing 

the religious purpose and nature of the activities of the organization; and

(2)

A currently valid determination letter from the IRS establishing that the organization is a tax-exempt 

organization;

8. The prospective employer is willing and able to provide salaried and/or non-salaried compensation at a Yes No

level that the beneficiary and any dependents will not become a public charge.

The funds to pay the beneficiary's compensation do not include any monies obtained from the beneficiary, 

excluding reasonable donations or tithing to the religious organization.

9. Yes No

Yes 

The offered position is full time, requiring at least an average of 35 hours of work per week.

Yes 

The beneficiary has been a member of the prospective employer's denomination for at least two years 

immediately before Form I-360 was filed.

13.

14.

Yes No

12. The beneficiary has been a religious worker for at least two years immediately before Form I-360 was No

filed and is otherwise qualified for the position offered.

11. Yes No

10. The beneficiary will not engage in secular employment, and the prospective employer will provide No

salaried and/or non-salaried compensation.

I certify or attest under penalty of perjury under the laws of the United States of America that the contents of this attestation, 

and the evidence submitted, are true and correct.

Prospective Employer Attestation (must be completed by the prospective employer even if the beneficiary is 

filing on his or her own behalf)

Signature of an Authorized Official of the Prospective Employer (sign in ink) Date of Signature (mm/dd/yyyy)

Answer Item Numbers 7. - 13. about the prospective employer. If you answer "No" for Item Numbers 7. - 13., provide an explanation 

in the space provided in Part 15. Additional Information.
Form I-360 Edition 04/01/24 Page 12 of 19

Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition (continued)

Title of the Signatory

Mailing Address

City or Town State ZIP Code

Employer/Organization Name

Street Number and Name Apt. Ste. Flr. Number

Contact Information

Daytime Telephone Number Fax Number (if any)

Email Address (if any) 

Religious Denomination Certification (to be completed only if the prospective employer is affiliated with a 

religious denomination)

I certify under penalty of perjury, that the prospective employer,

, and that the attesting

,

is affiliated with this Religious Denomination,

religious organization within the religious denomination is tax-exempt as described in section 501(c)(3) of the Internal Revenue Code 

of 1986, or equivalent sections of prior enactments of the Internal Revenue Code. The contents of this certification are true and 

correct to the best of my knowledge.

Signature of the Authorized Representative of the Religious Denomination (sign in ink) Date of Signature (mm/dd/yyyy)

Title of the Signatory

Printed Name and Title of the Signatory of the Religious Denomination

Family Name (Last Name) Given Name (First Name) Middle Name 

Printed Name and Title of Signatory for Prospective Employer

15. Family Name (Last Name) Given Name (First Name) Middle Name 

16.

17.

18.

20.

19.

21.

22.

23.
Form I-360 Edition 04/01/24 Page 13 of 19

Information About the Attesting Religious Organization Within the Religious Denomination 

City or Town State ZIP Code

Name of Attesting Religious Organization Within the Religious Denomination

Street Number and Name Apt. Ste. Flr. Number

Part 9. Complete Only If Filing a Special Immigrant Religious Worker Petition (continued)

Daytime Telephone Number Fax Number (if any)

Email Address (if any) IRS Tax Number of the Attesting Religious Organization

Part 10. Complete Only If Filing as a VAWA Self-Petitioning Spouse or Child of a U.S. Citizen or 

Lawful Permanent Resident or a VAWA Self-Petitioning Parent of a U.S. Citizen Son or Daughter

2. Date of Birth (mm/dd/yyyy) Country of Birth Date of Death (mm/dd/yyyy)

5.

3. 4.

Family Name (Last Name)

Full Name of U.S. citizen or Lawful Permanent Resident Abuser

Given Name (First Name) Middle Name 

1.

U.S. citizen through naturalization

D. U.S. Lawful Permanent Resident

Provide A-Number (if known)

Provide A-Number (if any) ► AC.

(1)

(1)

E. Other (Explain)

Your abuser is now, or was, a (Select one):

U.S. citizen born abroad to U.S. citizen parents

A. U.S. citizen born in the United States

B.

6. How many times have you been married?

7. How many times was your abuser married (if known)?

►

►

24.

25.

26. 27.

28. 29.

NOTE: For the safety and protection of all VAWA self-petitioners, information regarding a filing will only be provided to the 

self-petitioner or their designated attorney or representative with a valid Form G-28, Notice of Entry of Appearance as 

Attorney or Accredited Representative.

► A-
Form I-360 Edition 04/01/24 Page 14 of 19

Part 10. Complete Only If Filing as a VAWA Self-Petitioning Spouse or Child of a U.S. Citizen or 

Lawful Permanent Resident or a VAWA Self-Petitioning Parent of a U.S. Citizen Son or Daughter 

(continued)

When did you live with your abuser?

Include any other dates you have lived off/on with your abuser in the space provided in Part 15. Additional Information.

10. Provide the last address at which you lived together with your abuser.

9.

From (mm/dd/yyyy) To (mm/dd/yyyy)

City or Town State ZIP Code

Street Number and Name Apt. Ste. Flr. Number

Province Postal Code Country

11. Provide the last date that you lived together with your abuser at this address.

From (mm/dd/yyyy) To (mm/dd/yyyy)

12. I am currently residing in the United States and I request an Employment Authorization Document. Yes No

Part 11. Petitioner's Statement, Contact Information, Declaration, and Signature (Individual)

I can read and understand English, and I have read and understand every question and instruction on this petition and 

my answer to every question.

NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.

The interpreter named in Part 13. read to me every question and instruction on this petition and my answer to every

a language in which I am fluent. I understand all of this information as interpreted.

question in

At my request, the preparer named in Part 14., ,

prepared this petition for me based only upon information I provided or authorized.

1.

2. Petitioner's Statement Regarding the Preparer

Petitioner's Statement Regarding the Interpreter

A.

B.

NOTE: Read the Penalties section of the Form I-360 Instructions before completing this part.

, 

8. A. When did you and your abuser get married? (If you are a self-petitioning child or self-petitioning parent, type or print "N/A.")

(mm/dd/yyyy)

B. Where did you and your abuser get married? (If you are a self-petitioning child or self-petitioning parent, type or print "N/A.")

IMPORTANT: Complete this section ONLY if you are an individual filing this petition for yourself. If you are filing Form I-360 to 

petition for another person or as an authorized signatory of an organization, complete Part 12. Statement, Contact Information, 

Declaration, and Signature of the Petitioner or Authorized Signatory.

Petitioner's Statement
Form I-360 Edition 04/01/24 Page 15 of 19

Petitioner's Declaration and Certification

Petitioner's Signature

Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may 

require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any 

and all of my records that USCIS may need to determine my eligibility for the immigration benefit I seek.

I understand that USCIS may require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or 

signature) and, at that time, if I am required to provide biometrics, I will be required to sign an oath reaffirming that:

1) I provided or authorized all of the information contained in, and submitted with, my petition;

2) I reviewed and understood all of the information in, and submitted with, my petition; and

3) All of this information was complete, true, and correct at the time of filing.

I certify, under penalty of perjury, that all of the information in my petition and any document submitted with it were provided or 

authorized by me, that I reviewed and understand all of the information contained in, and submitted with, my petition, and that all of 

this information is complete, true, and correct.

6. Petitioner's Signature Date of Signature (mm/dd/yyyy)

I further authorize release of information contained in this petition, in supporting documents, and in my USCIS records to other 

entities and persons where necessary for the administration and enforcement of U.S. immigration laws.

NOTE TO ALL PETITIONERS: If you do not completely fill out this petition or fail to submit required documents listed in the 

Instructions, USCIS may deny your petition.

4. Petitioner's Mobile Telephone Number (if any)

5. Petitioner's Email Address (if any)

3. Petitioner's Daytime Telephone Number

Petitioner's Contact Information

Part 11. Petitioner's Statement, Contact Information, Declaration, and Signature (Individual) (continued)

Part 12. Statement, Contact Information, Declaration, and Signature of the Petitioner or Authorized 

Signatory

NOTE: Read the Penalties section of the Form I-360 Instructions before completing this part.

IMPORTANT: Complete this section ONLY if you are filing Form I-360 to petition for another person or as an authorized signatory 

of an organization. If you are an individual filing this petition for yourself, complete Part 11. Petitioner's Statement, Contact 

Information, Declaration, and Signature (Individual).

I can read and understand English, and I have read and understand every question and instruction on this petition and 

my answer to every question.

NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.

1. Petitioner's Statement Regarding the Interpreter

A.

Petitioner's or Authorized Signatory's Statement 

The interpreter named in Part 13. read to me every question and instruction on this petition and my answer to every

a language in which I am fluent. I understand all of this information as interpreted.

question in

B.

, 
Form I-360 Edition 04/01/24 Page 16 of 19

Petitioner's or Authorized Signatory's Declaration and Certification

Petitioner's or Authorized Signatory's Signature

8. Petitioner's or Authorized Signatory's Signature Date of Signature (mm/dd/yyyy)

NOTE TO ALL PETITIONERS AND AUTHORIZED SIGNATORIES: If you do not completely fill out this petition or fail to 

submit required documents listed in the Instructions, USCIS may delay a decision on or deny your petition.

Authorized Signatory's Mobile Telephone Number (if any)

4.

Authorized Signatory's Email Address (if any)

Authorized Signatory's Daytime Telephone Number

Authorized Signatory's Contact Information

At my request, the preparer named in Part 14., ,

prepared this petition for me based only upon information I provided or authorized.

2. Petitioner's Statement Regarding the Preparer

Part 12. Statement, Contact Information, Declaration, and Signature of the Petitioner or Authorized 

Signatory (continued)

Authorized Signatory's Family Name (Last Name)

6.

Authorized Signatory's Given Name (First Name)

Authorized Signatory's Title

7.

5.

3.

Copies of any documents submitted are exact photocopies of unaltered, original documents, and I understand that, as the petitioner, I 

may be required to submit original documents to USCIS at a later date.

I authorize the release of any information from my records, or from the petitioning organization's records, to USCIS or other entities 

and persons where necessary to determine eligibility for the immigration benefit sought or where authorized by law. I recognize the 

authority of USCIS to conduct audits of this petition using publicly available open source information. I also recognize that any 

supporting evidence submitted in support of this petition may be verified by USCIS through any means determined appropriate by 

USCIS, including but not limited to, on-site compliance reviews. 

If filing this petition on behalf of an organization, I certify that I am authorized to do so by the organization.

I certify, under penalty of perjury, that I have reviewed this petition, I understand all of the information contained in, and submitted 

with, my petition, and all of this information is complete, true, and correct.
Form I-360 Edition 04/01/24 Page 17 of 19

Interpreter's Contact Information

Interpreter's Certification

Interpreter's Signature

4. Interpreter's Daytime Telephone Number 5. Interpreter's Mobile Telephone Number (if any)

I am fluent in English and 

Item Number 1., or in Part 12., Item B. in Item Number 1., and I have read to this petitioner or the authorized signatory in the 

identified language every question and instruction on this petition and his or her answer to every question. The petitioner or 

authorized signatory informed me that he or she understands every instruction, question, and answer on the petition, including the 

Petitioner's Declaration and Certification, or Petitioner's or Authorized Signatory's Declaration and Certification, and has 

verified the accuracy of every answer.

I certify, under penalty of perjury, that:

, which is the same language specified in Part 11., Item B. in

7. Interpreter's Signature (sign in ink) Date of Signature (mm/dd/yyyy)

Interpreter's Mailing Address

City or Town State ZIP Code

Street Number and Name Apt. Ste. Flr. Number

Province Postal Code Country

3.

6. Interpreter's Email Address (if any)

Part 13. Interpreter's Contact Information, Certification, and Signature 

1. Interpreter's Family Name (Last Name)

Interpreter's Full Name

Interpreter's Given Name (First Name)

2. Interpreter's Business or Organization Name (if any)

Provide the following information about the interpreter.
Form I-360 Edition 04/01/24 Page 18 of 19

Preparer's Contact Information

4. Preparer's Daytime Telephone Number 5. Preparer's Mobile Number 

6. Preparer's Email Address (if any)

Preparer's Mailing Address

3.

City or Town State ZIP Code

Street Number and Name Apt. Ste. Flr. Number

Province Postal Code Country

Preparer's Statement

I am not an attorney or accredited representative but have prepared this petition on behalf of the 

petitioner and with the petitioner's consent.

I am an attorney or accredited representative and my representation of the petitioner in this case 

does not extend beyond the preparation of this petition.

7.

NOTE: If you are an attorney or accredited representative whose representation extends beyond 

preparation of this petition, you may be obliged to submit a completed Form G-28, Notice of Entry 

of Appearance as Attorney or Accredited Representative, or G-28I, Notice of Entry of Appearance 

as Attorney In Matters Outside the Geographical Confines of the United States, with this petition.

A.

B.

extends

Preparer's Certification

Preparer's Signature

By my signature, I certify, under penalty of perjury, that I prepared this petition at the request of the petitioner or authorized signatory. 

The petitioner has reviewed this completed petition, including the Petitioner's Declaration and Certification, or Petitioner's or 

Authorized Signatory's Declaration and Certification, and informed me that all of this information in the form and in the 

supporting documents is complete, true, and correct. 

8. Preparer's Signature (sign in ink) Date of Signature (mm/dd/yyyy)

Part 14. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other 

Than the Petitioner 

Preparer's Given Name (First Name)

2. Preparer's Business or Organization Name (if any)

Preparer's Full Name

Provide the following information about the preparer.

1. Preparer's Family Name (Last Name)
Form I-360 Edition 04/01/24 Page 19 of 19

Part 15. Additional Information

If you need extra space to provide any additional information within this petition, use the space below. If you need more space than 

what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Type or 

print your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to 

which your answer refers; and sign and date each sheet.

A-Number (if any) ► A3.

2.

Page Number B. Part Number C. Item Number

Page Number

5.

6. Page Number Part Number Item Number

Page Number Part Number Item Number

Part Number Item Number

1. Family Name (Last Name) Given Name (First Name) Middle Name

D.

4. B.

B.

B.

C.

C.

C.

D.

D.

D.

A.

A.

A.

A.