Application For Naturalization

USCIS
Form N-400

Department of Homeland Security
U.S. Citizenship and Immigration Services

For
USCIS
Use
Only

Date Stamp

Receipt

OMB No. 1615-0052
Expires 09/30/2015

Action Block

Remarks

Type or print all your answers in black ink. Type or print "N/A" if an item is not applicable or the answer is "none" unless otherwise indicated. Failure to answer all of the questions may delay USCIS processing your Form N-400. NOTE: You must complete Parts 1. - 14.

Part 1. Information About Your Eligibility (Check only one box or your
Form N-400 may be delayed)

Enter Your 9 Digit A-Number:
► A-

You are at least 18 years old and
1.

Have been a Permanent Resident of the United States for at least 5 years.

2.

Have been a Permanent Resident of the United States for at least 3 years. In addition, you have been married to and living with the same U.S. citizen spouse for the last 3 years, and your spouse has been a U.S. citizen for the last 3 years at the time of filing your Form N-400.

3.

Are a Permanent Resident of the United States, and you are the spouse of a U.S. citizen, and your U.S. citizen spouse is regularly engaged in specified employment abroad. (Section 319(b) of the Immigration and Nationality Act)

4.

Are applying on the basis of qualifying military service.

5.

Other (explain):

Part 2. Information About You (Person applying for naturalization)
1.

Your Current Legal Name (do not provide a nickname)
Family Name (Last Name)

2.

Middle Name (if applicable)

Your Name Exactly As It Appears on Your Permanent Resident Card (if applicable)
Family Name (Last Name)

3.

Given Name (First Name)

Given Name (First Name)

Middle Name (if applicable)

Other Name(s) You Have Used Since Birth (include nicknames, aliases, and maiden name if applicable)
Family Name (Last Name)

Form N-400 09/13/13 N

Given Name (First Name)

Middle Name (if applicable)

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Part 2. Information About You (continued)
4.

Name Change (optional)
Read the Form N-400 Instructions before you decide whether or not you would like to legally change your name.
Would you like to legally change your name?

Yes

If ''Yes," print the new name you would like to use in the space below.
Family Name (Last Name)
Given Name (First Name)

5.

U.S. Social Security Number
(if applicable)

6.

7.

Date of Birth
(mm/dd/yyyy)
►

No

Middle Name (if applicable)

Date You Became a Permanent Resident
(mm/dd/yyyy)
►

9.

Country of Citizenship or Nationality

8.

Country of Birth

10.

Are you requesting an accommodation(s) to the naturalization process because of a disability and/or an impairment? (See Form N-400 Instructions for accommodation examples)

Yes

No

If "Yes," check the box(es) below that applies:
Deaf or hard of hearing and need an interpreter who uses the following sign language (e.g., American Sign Language):
Use a wheelchair or other device that assists with mobility.
Blind or low vision.
Require another type of accommodation. (explain):

11.

Do you have a physical or developmental disability or mental impairment that prevents you from demonstrating your knowledge and understanding of the English language and/or civics requirements for naturalization?

Yes

No

If "Yes," submit a completed Form N-648, Medical Certification for Disability Exceptions, when you file your Form N-400.
12.

Exemptions from the English Language Test
A. Are you 50 years of age or older and have you lived in the United States as a Permanent Resident for periods totaling at least 20 years at the time of filing your Form N-400?

Yes

No

B. Are you 55 years of age or older and have you lived in the United States as a Permanent Resident for periods totaling at least 15 years at the time of filing your Form N-400?

Yes

No

C. Are you 65 years of age or older and have you lived in the United States as a Permanent Resident for periods totaling at least 20 years at the time of filing your Form N-400? (If you meet this requirement, you will also be given a simplified version of the civics test.)

Yes

No

Form N-400 09/13/13 N

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Part 3. Information to Contact You
1.
4.

Daytime Phone Number

(

)

2.

Work Phone Number (if any)

(

-

Mobile Phone Number (if any)
(
)

5.

)

3.

-

Evening Phone Number

(

)

-

E-mail Address (if any)

Part 4. Information About Your Residence
1.

Where have you lived during the last 5 years? Begin with where you live now and then list every location where you have lived during the last 5 years. If you need more space, use an additional sheet(s) of paper.
Date of Residence

From (mm/dd/yyyy) ►

To (mm/dd/yyyy) ►

Street Number and Name

Apt. Ste. Flr. Number

City

County

State

ZIP Code + 4
-

Province or Region (foreign address only)

Country (foreign address only)

Postal Code (foreign address only)

A. Mailing Address (if different from the address above)
C/O ("In Care Of" Name, if applicable)
Street Number and Name
City
Province or Region (foreign address only)

Form N-400 09/13/13 N

Apt. Ste. Flr. Number
State
Country (foreign address only)

ZIP Code + 4
Postal Code (foreign address only)

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Part 4. Information About Your Residence (continued)
2.

Date of Residence

From (mm/dd/yyyy) ►

To (mm/dd/yyyy) ►

Street Number and Name

Apt. Ste. Flr. Number

City

State

Province or Region (foreign address only)

3.

County
Country (foreign address only)

Postal Code (foreign address only)

Date of Residence

From (mm/dd/yyyy) ►

To (mm/dd/yyyy) ►

Street Number and Name

Apt. Ste. Flr. Number
County

City

ZIP Code + 4
-

State

ZIP Code + 4
-

Province or Region (foreign address only)

4.

Date of Residence

Country (foreign address only)

From (mm/dd/yyyy) ►

Postal Code (foreign address only)

To (mm/dd/yyyy) ►

Street Number and Name

Apt. Ste. Flr. Number

City

County

State

Province or Region (foreign address only)

Country (foreign address only)

Postal Code (foreign address only)

Form N-400 09/13/13 N

ZIP Code + 4
-

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Part 5. Information About Your Parents

If your biological or legally adoptive mother or father is a U.S. citizen by birth, or naturalized before you reached your 18th birthday, you may already be a U.S. citizen. Visit the USCIS Web site at www.uscis.gov for further information on this topic before you consider filing Form N-400.
1.

Were your parents married before your 18th birthday?

Yes

No

2.

Is your mother a U.S. citizen?
If "Yes," complete the following information.

Yes

No

A. Current Legal Name of U.S. Citizen Mother
Mother's Family Name (Last Name)
Mother's Given Name (First Name)

C. Mother's Date of Birth (mm/dd/yyyy)
►

B. Mother's Country of Birth

3.

Mother's Middle Name (if applicable)

Is your father a U.S. citizen?

Yes

No

If ''Yes," complete the information below.
A. Current Legal Name of U.S. Citizen Father
Father's Family Name (Last Name)
Father's Given Name (First Name)

Father's Middle Name (if applicable)

C. Father's Date of Birth (mm/dd/yyyy)

B. Father's Country of Birth

►

Part 6. Information for Criminal Records Check
NOTE: USCIS requires you to complete the categories below to conduct background checks. (See Form N-400 Instructions for more information) 1.

Gender

3.

Ethnicity (Select one)

Male

Female

Hispanic or Latino
4.

Height Feet

Inches

Not Hispanic or Latino

Race (Select one or more)
White

5.

2.

Asian

Black or
African American

Native Hawaiian or
Other Pacific Islander

American Indian or Alaska Native

Hair color
Black

Form N-400 09/13/13 N

Brown

Blonde

Gray

White

Red

Sandy

Bald (No hair)

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Part 6. Information for Criminal Records Check (continued)
6.

Eye color
Brown

Blue

Green

Hazel

Gray

Black

Pink

Maroon

Other

Part 7. Information About Your Employment and Schools You Attended
List where you have worked or attended school full time or part time during the last 5 years. Provide information for the complete time period. Include all military, police, and/or intelligence service. Begin by providing information about your most recent or current employment, studies, or unemployment (if applicable). Provide the locations and dates where you worked, were self-employed, were unemployed, or have studied for the last 5 years. If you worked for yourself, write "self-employed." If you were unemployed, write "unemployed." If you need more space, use an additional sheet(s) of paper to complete Part 7.
1.

Employer or School Name
Street Number and Name

Apt. Ste. Flr. Number
State

City

ZIP Code + 4
-

Province or Region (foreign address only)

Country (foreign address only)

Date From (mm/dd/yyyy)
►
2.

Date To (mm/dd/yyyy)

Postal Code (foreign address only)

Your Occupation

►

Employer or School Name
Street Number and Name

Apt. Ste. Flr. Number

City

State

ZIP Code + 4
-

Province or Region (foreign address only)

Date From (mm/dd/yyyy)
►

Form N-400 09/13/13 N

Country (foreign address only)

Date To (mm/dd/yyyy)
►

Postal Code (foreign address only)

Your Occupation

Page 6 of 21

Part 7. Information About Your Employment and Schools You Attended
(continued)
3.

A-

Employer or School Name
Street Number and Name

Apt. Ste. Flr. Number

City

State

ZIP Code + 4
-

Province or Region (foreign address only)
Date From (mm/dd/yyyy)
►

Country (foreign address only)

Date To (mm/dd/yyyy)
►

Postal Code (foreign address only)

Your Occupation

Part 8. Time Outside the United States
1.

How many total days (24 hours or longer) did you spend outside the United States during the last 5 years?

days

2.

How many trips of 24 hours or longer have you taken outside the United States during the last 5 years?

trips

3.

List below all the trips of 24 hours or longer that you have taken outside the United States during the last 5 years.
Begin with your most recent trip and work backwards. If you need more space, use an additional sheet(s) of paper.
Date You Left the
United States
(mm/dd/yyyy)

Date You Returned Did Trip Last 6 to the United States Months or More?
(mm/dd/yyyy)
Yes

No

Yes

No

Yes

No

Yes

Form N-400 09/13/13 N

No

Yes

Total Days
Outside the
United States

No

Yes

Countries to
Which You Traveled

No

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Part 9. Information About Your Marital History
1.

What is your current marital status?
Single, never married

Married

Separated

Divorced

Widowed

Marriage annulled

2.

If you are married, is your spouse a current member of the U.S. Armed Forces?

3.

How many times have you been married (including annulled marriages and marriage(s) to the same person)?

Yes

No

If you are single and have never been married, indicate "0" and go to Part 10.
4.

If you are married now, provide the following information about your current spouse.
A. Legal Name of Current Spouse
Family Name (Last Name)

Given Name (First Name)

Middle Name (if applicable)

Given Name (First Name)

Middle Name (if applicable)

B. Previous Legal Name of Current Spouse
Family Name (Last Name)

C. Other Names Used by Current Spouse (include nicknames, aliases, and maiden name, if applicable)
Family Name (Last Name)

Given Name (First Name)

D. Current Spouse's Date of Birth
(mm/dd/yyyy) ►

Middle Name (if applicable)

E. Date You Entered into Marriage with Current Spouse
(mm/dd/yyyy) ►

F. Current Spouse's Present Home Address
Street Number and Name

Apt. Ste. Flr. Number

City

County

State

ZIP Code + 4
-

Province or Region (foreign address only)

Country (foreign address only)

Postal Code (foreign address only)

G. Current Spouse's Present Employer

5.

Is your current spouse a U.S. citizen?

Yes

No

If ''Yes," answer Item Number 6.
If ''No," go to Item Number 7.

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Part 9. Information About Your Marital History (continued)
6.

If your current spouse is a U.S. citizen, complete the following information.
A. When did your current spouse become a U.S. citizen?
At birth - Go to Item Number 8.
Other - Complete the following information.
B. Date your current spouse became a U.S. citizen
(mm/dd/yyyy) ►

7.

If your current spouse is not a U.S. citizen, complete the following information.
A. Current Spouse's Country of Citizenship or Nationality

B. Current Spouse's A-Number (if applicable)
► A-

C.