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I-360fillable (ILW.COM)

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Beneficiary
Interviewed
For USCIS Use Only
Part 1. Information about person or organization filing this
petition.
(Individuals should use the top name line; organizations should
use the second line.) If you are a self-petitioning spouse or child and do not
want USCIS to send notices about this petition to your home, you may
show an alternate mailing address here. If you are filing for yourself and do
not want to use an alternate mailing address, skip to Part 2.
Returned
Receipt
Resubmitted
Given Name
Middle Name
Family Name
Company or Organization
Name
Reloc Sent
Address - C/O
Street Number
and Name
Reloc Rec'd
City
State or
Province
Zip/Postal
Code
Country
IRS Tax #
A#
U.S. Social
Security #
Petitioner/
Applicant
Interviewed
(if any)
Part 2. Classification Requested (check one):
a.
Amerasian
b.
Widow(er) of a U.S. citizen who died within the past two (2) years
I-485 Filed Concurrently
Bene "A" File Reviewed
Classification
Consulate
Priority Date
Special Immigrant Juvenile
c.
d.
Special Immigrant Religious Worker
e.
f.
Special Immigrant Physician
Special Immigrant International Organization Employee or family member
g.
Special Immigrant Armed Forces Member
h.
Self-Petitioning Spouse of Abusive U.S. Citizen or Lawful Permanent Resident
i.
Self-Petitioning Child of Abusive U.S. Citizen or Lawful Permanent Resident
j.
Remarks:
k.
Special Immigrant Iraq National who was employed by or on behalf of the United
States Government
l.
Other, explain:
m.
Special Immigrant Afghanistan or Iraq National who worked with the U.S. Armed
Forces as a translator
Part 3. Information about the person this petition is for
Action Block
Address - C/O
Apt. #
Street Number and Name
City
State or Province
Zip/Postal Code
Country
To Be Completed by
Attorney or Representative, if any
Fill in box if G-28 is attached to
represent the applicant
VOLAG#
ATTY State License #
START HERE - Please type or print in black ink
Department of Homeland Security
U.S. Citizenship and Immigration Services
Form I-360 (Rev. 05/27/08)Y
OMB No. 1615-0020; Expires 10/31/08
Special Immigrant based on employment with the Panama Canal Company, Canal
Zone Government or U.S. Government in the Canal Zone
I-360, Petition for Amerasian,
Widow(er), or Special Immigrant
Middle Name
Given Name
Family Name
(Explain on a separate sheet of paper)
Part 4. Processing Information
Below give information on U.S. consulate you want notified if this petition is approved and if any requested adjustment of status cannot be granted.
Country
If you gave a United States address in Part 3, print the person's foreign address below. If his or her native alphabet does not use Roman letters, print
his or her name and foreign address in the native alphabet.
Name
Address
Male
Female
Gender of the person this petition is for
No
(How many?
)
No
Has the person this petition is for ever worked in the U.S. without permission?
No
(Explain on a separate sheet of paper)
No
Yes
Is an application for adjustment of status attached to this petition?
Part 5. Complete only if filing for an Amerasian
Section A. Information about the mother of the Amerasian
Living?
(attach a full explanation)
(Give date of death
(complete address line below)
)
Address
Section B. Information about the father of the Amerasian: If possible, attach a notarized statement from the father regarding parentage.
Explain on separate paper any question you cannot fully answer in the space provided on this form. (attach a full explanation)
Date of Birth
(mm/dd/yyyy)
Country of
Birth
Home Address
Home
Phone #
Work
Phone #
American Consulate: City
Is the person this petition is for in deportation or removal proceedings?
Form I-360 (Rev. 05/27/08)Y Page 2
Middle Name
Given Name
Family Name
Middle Name
Given Name
Family Name
Are you filing any other petitions or applications with this one?
No
Yes
Unknown
Living?
(Give date of death
(complete address line below)
)
No
Yes
Unknown
Yes
Yes
Yes
Date of Birth (mm/dd/yyyy)
Country of Birth
A # (if any)
U.S. Social Security #
Marital Status:
Widowed
Married
Divorced
Single
Complete the items below if this person is in the United States:
I-94#
Expires on (mm/dd/yyyy)
Date of Arrival (mm/dd/yyyy)
Current Nonimmigrant Status
Part 3. Information about the person this petition is for (Continued.)
If you are filing as a self-petitioning spouse, have any of your children filed separate self-petitions?
Part 7. Complete only if filing as a Widow/Widower, a Self-petitioning Spouse of an Abuser,
or as a Self-petitioning Child of an Abuser
Section A. Information about the U.S. citizen husband or wife who died or about the U.S. citizen or lawful permanent resident abuser
Date of Birth
(mm/dd/yyyy)
Date of Death
Country of
Birth
(mm/dd/yyyy)
He or she is now, or was at time of death a (check one):
U.S. citizen through naturalization (Show A #)
U.S. citizen born in the United States.
U.S. lawful permanent resident (Show A #)
U.S. citizen born abroad to U.S. citizen parents.
Other, explain
How many times
have you been married?
Give the date and place where you and the person in Section A were
married. (If you are a self-petitioning child, write: "N/A")
How many times was the person in
Section A married?
When did you live with the person named in Section A? From (Month/Year)
until (Month/Year)
If you are filing as a widow/widower, were you legally separated at the time of the U.S citizens's death?
No
Yes, (attach explanation).
Give the last address at which you lived together with the person named in Section A, and show the last date that you lived together with that person
at that address:
Yes (show child(ren)'s full names):
No
Section B. Additional Information about you.
Form I-360 (Rev. 05/27/08)Y Page 3
Middle Name
Given Name
Family Name
Part 6. Complete only if filing for a Special Immigrant Juvenile Court Dependent
Answer the following questions regarding the person this petition is for. If you answer "No," explain on a separate sheet of paper.
Is he or she still dependent upon the juvenile court or still legally committed to or under the custody of an agency
Section A. Information about the Juvenile
List any other
names used.
No
Yes
or department of a state?
No
Yes
Does he or she continue to be eligible for long-term foster care?
Part 5. Complete only if filing for an Amerasian (Continued.)
At the time the Amerasian was conceived:
The father was in the military (indicate branch of service below and give service number here):
Army
Air Force
Coast Guard
Navy
Marine Corps
The father was not in the military, and was not a civilian employed abroad. (Attach a full explanation of the circumstances.)
The father was a civilian employed abroad. Attach a list of names and addresses of organizations which employed him at that time.
Form I-360 (Rev. 05/27/08)Y Page 4
Date of Birth
(mm/dd/yyyy)
Country of Birth
Relationship
A #
Child
Date of Birth
(mm/dd/yyyy)
A #
Country of Birth
Child
Relationship
Middle Name
Given Name
F. Family Name
H. Family Name
Middle Name
Given Name
Date of Birth
(mm/dd/yyyy)
Country of Birth
Relationship
A #
Child
Middle Name
Given Name
G. Family Name
Date of Birth
(mm/dd/yyyy)
Country of Birth
A #
Relationship
Child
Middle Name
Given Name
E. Family Name
A #
Date of Birth
(mm/dd/yyyy)
Country of Birth
Relationship
Child
Middle Name
Given Name
D. Family Name
Part 8. Information about the spouse and children of the person this petition is for
A widow/widower or a self-petitioning spouse of an abusive citizen or lawful permanent resident should also list the children of the
deceased spouse or of the abuser.
Date of Birth
(mm/dd/yyyy)
Country of Birth
Relationship
A #
Spouse
Child
Date of Birth
(mm/dd/yyyy)
A #
Country of Birth
Child
Date of Birth
(mm/dd/yyyy)
Country of Birth
A #
Relationship
Child
Relationship
Middle Name
Given Name
A. Family Name
B. Family Name
C. Family Name
Middle Name
Given Name
Middle Name
Given Name
Read the information on penalties in the instructions before completing this part. If you are going to file this petition at
a USCIS office in the United States, sign below. If you are going to file it at a U.S. consulate or USCIS office overseas,
sign in front of a USCIS or consular official.
Part 9. Signature
I certify, or, if outside the United States, I swear or affirm, under penalty of perjury under the laws of the United States of America,
that this petition and the evidence submitted with it is all true and correct. If filing this on behalf at an organization, I certify that I am
empowered to do so by that organization. I authorize the release of any information from my records, or from the petitioning
organization's records, that U.S. Citizenship and Immigration Services needs to determine eligibility for the benefit being sought.
Date
E-mail Address
Signature
Print Name
Date
Signature of USCIS
or Consular Official
NOTE: If you do not completely fill out this petition or fail to submit required documents listed in the instructions, the person(s) filed
for may not be found eligible for a requested benefit and the petition may be denied.
Part 10. Signature of person preparing form, if other than above (Sign below)
I declare that I prepared this application at the request of the above person and it is based on all information of which I have
knowledge.
Print Your Name
Date
Signature
Firm Name and Address
Form I-360 (Rev. 05/27/08)Y Page 5
E-mail Address
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Completed 9 January 2021

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