Application for Entrepreneur Parole

• Legal Form Number: I-941
• Section: Citizenship and Immigration Services (United States of America)
• Issuer: Citizenship and Immigration Services (United States of America)

Form I-941 07/21/22 Page 1 of 15

Application for Entrepreneur Parole

Department of Homeland Security

U.S. Citizenship and Immigration Services

For

USCIS

Use

Only

USCIS

Form I-941

OMB No. 1615-0136

Expires 07/31/2025

Action BlockReceipt

Remarks

Attorney State Bar Number

(if applicable) Attorney or Accredited Representative

USCIS Online Account Number (if any)

Part 1. Information About the Entrepreneur

(Applicant)

3.b.

3.c.

3.a. Family Name

(Last Name)

Given Name

(First Name)

Middle Name

►

Your Full Name

I am requesting:

Initial Parole

Re-Parole

1.c. Amended Application

If you are requesting a re-parole or filing an amended application,

provide the Receipt Number of your current Form I-941 approval

in Item Number 2. below.

1.a.

1.b.

2.

OR

OR

8. Date of Birth (mm/dd/yyyy)

Sex Male Female9.

7.

USCIS Online Account Number (if any)6.

►

Other Information

5.

►A-

Alien Registration Number (A-Number)

4.b.

4.c.

4.a. Family Name

(Last Name)

Given Name

(First Name)

Middle Name

Receipt Number

►

Other Names Used

Provide any other names you have used since birth, including

aliases, maiden names, and nicknames. If you need extra space

to complete this section, use the space provided in Part 10.

Additional Information.

U.S. Social Security Number (if any)

►

10. Marital Status

WidowedDivorcedSingle Married

START HERE - Type or print in black ink.

Select this box if

Form G-28 or

G-28I is attached.

To be completed by an

attorney or accredited

representative (if any).