Part 1: Information about you
A-
Leave blank if not applicable.
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Please enter a valid A-Number (up to 9 digits) or leave
blank if not applicable.
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Please enter USCIS ONline Account Number or leave blank if not
applicable.
Your full name
NOTE: Your card will be issued in this name.
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Please enter your family name (last name).
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Please enter your given name (first name).
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Please enter your middle name if applicable.
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Please select whether your name has legally changed.
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Please provide your new family name (last name).
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Please provide your new given name (first name).
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Please provide your new middle name if applicable.
Mailing Address
NOTE: USPS ZIP
Code Lookup
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Please enter the “In Care Of” name if applicable.
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Please enter your street number and name.
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Please select apartment/suite/floor, if applicable.
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Please enter your apartment/suite/floor number, if applicable.
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Please enter your city or town.
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Please select your state.
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Please enter your province if applicable.
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Please enter your postal code if applicable.
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Please enter your country if applicable.
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Please select whether your physical and mailing address are
the same.
Physical Address
NOTE: Provide this information only if different than mailing address
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Please enter your physical street number and name.
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Please select apartment/suite/floor, if applicable.
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Please enter your apartment/suite/floor number, if applicable.
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Please enter your physical city or town.
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Please select your physical state.
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Please enter your province if applicable.
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Please enter your postal code if applicable.
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Please enter your country if applicable.
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Please select your sex.
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Please enter your date of birth.
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Please enter your city, town, or village of birth.
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Please enter your country of birth.
Mother's Name
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Please enter your mother’s given name (first name).
Father's Name
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Please enter your father’s given name (first name).
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Please enter your class of admission.
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Please enter Date of admission.
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Please enter a valid 9-digit Social Security Number or leave
blank if not applicable.