Petition for U Nonimmigrant Status

• Legal Form Number: I-918
• Section: Citizenship and Immigration Services (United States of America)
• Issuer: Citizenship and Immigration Services (United States of America)

Form I-918 Edition 12/06/21 Page 1 of 11

To be completed by an

attorney or accredited

representative (if any).

START HERE - Type or print in black or blue ink.►

Part 1. Information About You

(Person filing this

petition as a victim)

1.a. Family Name

(Last Name)

1.b. Given Name

(First Name)

1.c. Middle Name

Safe Mailing Address (if other than Home Address)

Street Number

and Name

4.b.

4.d. City or Town

4.e. State 4.f. ZIP Code

4.c. Ste. Flr.Apt.

Street Number

and Name

3.a.

3.c. City or Town

3.d. State 3.e. ZIP Code

3.b. Ste. Flr.Apt.

Home Address

In Care Of Name

Other Names Used (Include maiden name, nicknames, and

aliases, if applicable)

2.a. Family Name

(Last Name)

2.b. Given Name

(First Name)

2.c. Middle Name

4.a.

Province

4.g.

Postal Code4.h.

4.i. Country

For

USCIS

Use

Only

Action Block

Receipt

U.S.

Embassy

Consulate

Validity Dates (mm/dd/yyyy)

To: / / /

From: / / /

Wait Listed

Stamp Number Date (mm/dd/yyyy)

Remarks

3.f.

Postal Code3.g.

Province

3.h. Country

Alien Registration Number (A-Number) (if any)

6.

USCIS Online Account Number (if any)7.

5.

►A-

U.S. Social Security Number (if any)

Other Information

MarriedSingle Divorced

Marital Status

Widowed

8.

►

►

USCIS

Form I-918

OMB No. 1615-0104

Expires 06/30/2023

Petition for U Nonimmigrant Status

Department of Homeland Security

U.S. Citizenship and Immigration Services

Attorney or Accredited Representative

USCIS Online Account Number (if any)

Attorney State Bar Number

(if applicable)

Select this box if

Form G-28 is

attached.

(USPS ZIP Code Lookup)

Form I-918 Edition 12/06/21 Page 2 of 11

I am under 16 years of age.

I am submitting Form I-918, Supplement B, U

Nonimmigrant Status Certification, from a certifying

official.

I possess information concerning the criminal activity of

which I was a victim.

Part 1. Information About You (continued)

12.

15.

17.

16.

18.

19.a.

19.b.

20.

1.

2.

3.

4.

5.

6.

7.a.

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Select "Yes" or "No," as appropriate, for each of the following

questions.

I was or am in immigration proceedings.

The crime of which I am a victim occurred in the United

States (including Indian country and military installations)

or violated the laws of the United States.

I have suffered substantial physical or mental abuse as a

result of having been a victim of this criminal activity.

I am a victim of criminal activity listed in the INA at

section 101(a)(15)(U)(iii).11.

Date of Issuance for Passport or Travel Document

(mm/dd/yyyy)

Form I-94 Arrival-Departure Record Number

Passport Number

Travel Document Number

Country of Issuance for Passport or Travel Document

Expiration Date for Passport or Travel Document

(mm/dd/yyyy)

13.

Country of Citizenship or Nationality

14.

Country of Birth

Date of Last Entry into the United States

(mm/dd/yyyy)

22.

Place and Date of Last Entry into the United States and Date

Authorized Stay Expired

Current Immigration Status

7.c.

Exclusion Date (mm/dd/yyyy)

Exclusion Proceedings

Removal Date (mm/dd/yyyy)

Removal Proceedings

7.b.

If you answered "Yes," select the type of proceedings. If you

were in proceedings in the past and are no longer in proceedings,

provide the date of action. If you are currently in proceedings,

type or print “Current” in the appropriate date field. Select all

applicable boxes. Use the space provided in Part 8. Additional

Information to provide an explanation.

Part 2. Additional Information About You

Answering “Yes” to the following questions below requires

explanations and supporting documentation. Attach relevant

documents in support of your claims that you are a victim of

criminal activity listed in the Immigration and Nationality Act

(INA) section 101(a)(15)(U)(iii). You must also attach a

personal narrative statement describing the criminal activity of

which you are a victim. If you are only petitioning for U

derivative status for qualifying family members subsequent to

your (the principal petitioner) initial filing, you are not required

to submit evidence supporting the original petition with the new

Form I-918.

Rescission Proceedings7.e.

Judicial Date (mm/dd/yyyy)

7.f.

Rescission Date (mm/dd/yyyy)

Judicial Proceedings

Deportation Proceedings

Deportation Date (mm/dd/yyyy)

7.d.

►

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

9. Gender Male Female

If you need extra space to complete Part 2., use the space

provided in Part 8. Additional Information.

State

City or Town

21. Date Authorized Stay Expired (mm/dd/yyyy)

NoYes