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. Mother's Full Name 8. Mother's Address; County, Town, and State; Mailing Address; Cell Phone Number 9. Spouse's Address; County, Town, and State; Postal Code 10. Address for children under age 18; Phone (In native alphabet) 11. Address for dependent children under age 21; Mobile and Work Phone Number 12. Date of Birth 13. Current Birthdate (If Age Unverified) 14. Place of Birth 15. Residence Name and Address (If applicable) 1. School Name (If applicable) 2. Last Two (2) Names of Grandparent(s) if applicable (is the name of the Grandparent/Sibling has been removed on Form I-765, “Application for Alien Relative to Be Eligible for Special Immigrant Visa” from the USCIS website, it will be necessary to use the above information. The parent's name will not appear on the application, but the original I-765 will still be needed) 3. Original Birth Date (If Age Unverified) 4. Address for parent and/or child (if applicable) 5. Name and Address of Residence for parent and/or child (if applicable) 6. Occupation of Occupation (If applicable) 7. Social Security Number of Occupation (If applicable) 8. Current Employment Information (If applicable) 9. Address for employer and/or other employee (if applicable) 10. Spouse's Address; County, Town, and State; Mailing Address; Cell Phone Number (if applicable) 11. Spouse's Address; County, Town, and State; Postal Code 12. Address for dependent children under age 18; Mobile and Work Phone Number, or Current Home Phone Number (if applicable) 13. Spouse name, address, employer, and occupation of parent (if applicable) (if applicable) 14. Address for dependent children under age 21; address for parent (if applicable) 15. Address for dependent children under age 21 (if applicable) 16. Employment Status and Employment Periods to be Used (if applicable) 17. Current Income Information (if applicable) Is any of the Social Security numbers in Section I have been removed due to being outdated or inaccurate after the alien came to the United States, you are not required to provide it anymore. This section of the application only contains the original SSS/IAS number. The original SSS/IAS number is only required to prove citizenship or lawful immigration status.

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