|Mental institution||Hospital specializing in the treatment of persons with mental illness.|
|Legally incompetent||Confined to care because of severe mental illness. Not allowed to live your daily life.|
|Affiliation||belonging to a particular religious or political group|
|Association||you support and agree with a group or person|
|Party||an organization of people who have similar political beliefs and ideas and who work to have their members elected to positions in the government|
Part 9: Information about your children.
- 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.
- Provide the following information about all of you 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)|
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
- Have you ever claimed to be a US citizen(in writing or any other way)? Yes No (Have you ever told anyone that you were a US citizen when you are not?)
- Have you ever registered to vote in any Federal, state or local election in the United States? Yes No
- Have you ever voted in any Federal, state or local election in the United States?
- Since becoming a Lawful Permanent Resident, have you ever failed to file a required Federal state or local tax return? (Have you ever been told you needed to file for taxes and not done it?)
- Do you owe any Federal, state or local taxes that are overdue? (Have you ever been told you need to pay taxes and not done it?)
- Do you have any title of nobility in any foreign country? (For example king, queen, princess, prince, duchess, etc.)
- Have you ever been declared legally incompetent or been confined to a mental institution within the last five years?
QUESTIONS below in blue are taken from the 100 Questions.
48) There are four amendments to the Constitution about who can vote. Describe one of them.
– Citizens eighteen (18) and older (can vote)
– You don’t have to pay (a poll tax) to vote.
– Any citizen can vote. (Women and men can vote.)
– A male citizen of any race (can vote).
Voting is one of the most important civic responsibilities of citizens in the United States. In a democratic society, the people choose the leaders who will represent them.
49) What is one responsibility that is only for United States citizens?
– serve on a jury
-vote in a federal election
Two responsibilities of U.S. citizens are to serve on a jury and vote in federal elections. The Constitution gives citizens the right to a trial by a jury. The jury is made up of U.S. citizens. Participation of citizens on a jury helps ensure a fair trial. Another important responsibility of citizens is voting. The law does not require citizens to vote, but voting is a very important part of any democracy. By voting, citizens are participating in the democratic process. Citizens vote for leaders to represent them and their ideas, and the leaders support the citizens’ interests.
50) Name one right only for United States Citizens.
-vote in a federal election
-run for federal office
U.S. citizens have the right to vote in federal elections. Permanent residents can vote in local or state elections that do not require voters to be U.S. citizens. Only U.S. citizens can vote in federal elections. U.S. citizens can also run for federal office.
54) How old do citizens have to be to vote for President?
-eighteen (18) and older
For most of U.S. history, Americans had to be at least 21 years old to vote. At the time of the Vietnam War, during the 1960s and 1970s, many people thought that people who were old enough to fight in a war should also be old enough to vote. In 1971, the 26thAmendment changed the minimum voting age from 21 to 18 for all federal, state, and local elections. The National Voter Registration Act of 1993 made it easier for people to register to vote. Now they can register to vote by mail, at public assistance offices, or when they apply for or renew their driver’s license.
56) When is the last day you can send in federal income tax form?
The last day to send in your federal income tax to the Internal Revenue Service is April 15 of each year. The Constitution gave the federal government the power to collect taxes. The federal government needs money to pay the nation’s debts and to defend and provide for the needs of the country.
8a. 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?
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|
9. Have you ever been a member of or in any way associated (either directly or indirectly) with:
a. The Communist Party?
b. Any other totalitarian party?
c. A terrorist organization?
10. Have you ever advocated (either directly or indirectly) the overthrow of any government by force or violence? (Have you ever publicly recommended to end a government with violent behavior?)
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? (Have you ever caused any person to suffer because of their beliefs?)
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?
b. Any government in any area (1) occupied by, (2) allied with, or (3) established with the help of the Nazi government of Germany?
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?
55) What are two ways that Americans can participate in their democracy?
-join a political party
-help with a campaign
-join a civic group
-Join community group
-Give an elected official your opinion on an issue
-Call Senators and Representatives
-Publicly support or oppose an issue or policy
-run for office
-write to a newspaper
Citizens play an active part in their communities. When Americans engage in the political process, democracy stays alive and strong. There are many ways for people to be involved. They can volunteer to help new immigrants learn English and civics, join the Parent Teacher Association (PTA) of their child’s school, run for a position on the local school board, or volunteer to help at a polling station. People can also vote, help with a political campaign, join a civic or community organization, or call their senator or representative about an issue that is important to them.
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?
14. Have you ever failed to file a federal, state or local tax return because you considered yourself to be a “nonresident”?
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?
16. Have you ever been arrested, cited or detained by any law enforcement officer (including USCIS or former INS and military officers) for any reason?
17. Have you ever been charged with committing any crime or offense? (Have you ever been accused of a crime or offense by a law officer?)
18. Have you ever been convicted of a crime or offense? (Have law officers ever proved you have committed a crime?)
19. Have you ever been placed in an alternative sentencing or a rehabilitative program (for example: diversion, deferred prosecution, withheld adjudication, deferred adjudication)?
20. Have you ever received a suspended sentence, been placed on probation or been paroled?
21. Have you ever been in jail or prison?
If you answered “Yes” to any of Questions 15-21, 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.)|
Answer Questions 22-33. 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? (A person who often gets drunk on alcohol)
b. Been a prostitute, or procured anyone for prostitution? (Found a prostitute for someone or been a prostitute.)
c. Sold or smuggled controlled substances, illegal drugs or narcotics?
d. Been married to more than one person at the same time?
e. Helped anyone enter or try to enter the United States illegally?
f. Gambled illegally or received income from illegal gambling?
g. Failed to support your dependents or to pay alimony?
23. Have you ever given false or misleading information to any US government official while applying for any immigration benefit or to prevent deportation, exclusion or removal?
24. Have you ever lied to any US government official to gain entry or admission to the United States?
E. Removal, Exclusion and Deportation Proceedings.
25. Are removal, exclusion, rescission or deportation proceedings pending against you?
26. Have you ever been removed, excluded or deported from the United States?
27. Have you ever been ordered to be removed, excluded or deported from the United
28. Have you ever applied for any kind of relief from removal, exclusion or deportation?
F. Military Service.
29. Have you ever served in the US Armed Forces?
30. Have you ever left the United States to avoid being drafted into the US Armed Forces?
31. Have you ever applied for any kind of exemption from military service in the US Armed
32. Have you ever deserted from the US Armed forces?
G. Selective Service Registration. (US Military Draft 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?
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.
57) When must all men register for the Selective Service?
-at age eighteen (18)
-between eighteen (18) and twenty-six (26)
In 1940, President Franklin Roosevelt signed the Selective Training and Service Act, which created the first draft during peacetime. This was the beginning of the Selective Service System in the United States today. The draft was needed again for the Korean and Vietnam Wars. Today, there is no draft, but all men between 18 and 26 years old must register with the Selective Service System. When a man registers, he tells the government that he is available to serve in the U.S. Armed Forces. He can register at a United States post office or on the Internet. To register for Selective Service on the Internet, visit the Selective Service website at www.sss.gov.
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?
35. Do you understand the full Oath of Allegiance to the United States?
36. Are you willing to take the full Oath of Allegiance to the United States?
37. If the law requires it, are you willing to bear arms on behalf of the United States?
38. If the law requires it, are you willing to perform noncombatant services in the US Armed
39. If the law requires it, are you willing to perform work of national importance under
53) What is one promise you make when you become a United States citizen?
-give up loyalty to other countries
-defend the Constitution and laws of the United States
-obey the laws of the United States
-Serve in the US Military (if needed)
-serve (do important work for) the nation (if needed)
-be loyal to the United States
When the United States became an independent country, the Constitution gave Congress the power to establish a uniform rule of naturalization. Congress made rules about how immigrants could become citizens. Many of these requirements are still valid today, such as the requirements to live in the United States for a specific period of time, to be of good moral character, and to understand and support the principles of the Constitution. After an immigrant fulfills all of the requirements to become a U.S. citizen, the final step is to take an Oath of Allegiance at a naturalization ceremony.
Part 11: Your Signature
I certify, under penalty of the 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 the USCIS needs to determine my eligibility for naturalization.
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 question: contained on this form.
Preparers Printed Name
Preparer’s Firm or Organization Name
Preparers Daytime Phone Number
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 _______________Officers Printed Name or Stamp ______Date
Complete Signature of Applicant ________________ Officers 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:__________________________
Section 4 Vocabulary Quiz: Choose the definition and type the letter in the blank.
Mental institution _____
Legally incompetent _____
A. an organization of people who have similar political beliefs and ideas and who work to have their members elected to positions in the government
B. you support and agree with a group or person
C. Confined to care because of severe mental illness. Not allowed to live your daily life.
D. Hospital specializing in the treatment of persons with mental illness.
E. belonging to a particular religious or political group