Form I-918 Supplement A 02/07/17 N
Page 6 of 12
In any way compelled or forced to engage in any kind of
sexual contact or relations?
Displaced or moved from his or her residence by force,
compulsion, or duress?
Has your family member EVER, during the period of
March 23, 1933 to May 8, 1945, in association with either
the Nazi Government of Germany or any organization or
government associated or allied with the Nazi Government
of Germany, ordered, incited, assisted or otherwise
participated in the persecution of any person because of
race, religion, nationality, membership in a particular
social group or political opinion?
Part 5. Processing Information (continued)
9.
Yes No
Yes No
Yes No
Yes No
Intentionally killed, tortured, beaten, or injured?
Has your family member EVER been present or nearby when
any person was:
12.a.
12.b.
12.c.
NOTE: If you answered "Yes" to any question in Item
Numbers 10.a. - 10.g., please describe the circumstances in the
spaces provided in Part 11. Additional Information.
Has your family member EVER advocated that another
person commit any of the acts described in Item
Numbers 10.a. - 10.g., urged, or encouraged another
person, to commit such acts?
Yes No
11.
Limiting or denying any person's ability to exercise
religious beliefs?
Yes No
10.e.
The persecution of any person because of race, religion,
national origin, membership in a particular social group,
or political opinion?
Yes No
10.f.
Displacing or moving any person from their residence by
force, threat of force, compulsion, or duress?
Yes No
10.g.
Engaging in any kind of sexual conduct or relations with
any person who was being forced or threatened?
Yes No
10.d.
Intentionally and severely injuring any person?
Yes No
10.c.
Acts involving torture or genocide?
Yes No10.a.
Has your family member EVER ordered, incited, called for,
committed, assisted, helped with, or otherwise participated in any
of the following:
Killing any person?
Yes No10.b.
Has your family member EVER:
Served in any prison, jail, prison camp, detention facility,
labor camp, or any other situation that involved detaining
persons?
Served in, been a member of, assisted in, or participated
in any military unit, paramilitary unit, police unit, self-
defense unit, vigilante unit, rebel group, guerilla group,
militia, or other insurgent organization?
13.a.
13.b.
Yes No
Yes No
Served in, been a member of, assisted in, or participated
in any group, unit, or organization of any kind in which
you or other persons transported, possessed, or used any
type of weapon?
13.c.
Yes No
NOTE: If you answered "Yes" to any question in Item
Numbers 13.a. - 13.c., please describe the circumstances in
Part 11. Additional Information.
Has your family member EVER had removal, exclusion,
rescission, or deportation proceedings initiated against
him or her?
17.
Yes No
Recruited, enlisted, conscripted, or used any person under 15
years of age to serve in or help an armed force or group?
Is your family member NOW in removal, exclusion,
rescission, or deportation proceedings?
16.
Yes No
Used any person under 15 years of age to take part in
hostilities, or to help or provide services to people in
combat?
15.b.
Yes
No
15.a.
Yes
No
NOTE: If you answered "Yes" to any question in Item
Numbers 14.a. - 14.c., please describe the circumstances in
Part 11. Additional Information.
Assisted or participated in selling or providing weapons to
any person who to your knowledge used them against
another person, or in transporting weapons to any person
who to your knowledge used them against another
person?
14.c.
Yes No
Been a member of, assisted in, or participated in any
group, unit, or organization of any kind in which you or
other persons used any type of weapon against any person
or threatened to do so?
Yes No
14.b.
Received any type of military, paramilitary, or weapons
training?
14.a.
Yes No
Has your family member EVER:
Has your family member EVER: