Citizenship Clinic Questionnaires | Adoptee Rights Law Center

Confidential and non-identifying questionnaire used to answer many of the questions required on the N-400 (Application for Naturalization).

Note: this questionnaire can only be submitted if you have received a code from the Adoptee Rights Law Center. Without that code, which is unique to each client, you cannot submit the information on this form.

Step 1 of 2 – Personal Information

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Personal Information

Many of these questions are actual questions from the N-400 application. Not all the questions on the N-400 are listed below.

Date of Birth(Required)

I need this to verify your identity.

Month

Day

Year

Country of Birth(Required)

For verifying your identity.

Would you like to legally change your name through naturalization??(Required)

Changing your name as part of the application is possible, though it typically requires appearing before a judge at the time of taking the oath of citizenship

Yes

Ethnicity(Required)

Select only one

Hispanic or Latino

Not Hispanic or Latino

Race(Required)

Select all that are applicable to you

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

What is your height, in feet and inches?

For example: 5 feet 7 inches

Eye Color(Required)

Choose only one

Hair Color(Required)

Choose only one

What is your current marital status?(Required)

Single, never married

Married

Divorced

Widowed

Separated

Marriage Annulled

How many times have you been married?

Do you currently have any children who are under 18 years of age?(Required)

Yes

Total number of children under 18 years of age

Please enter a number from 1 to 10.

Your Minor Children

Provide the following information about your minor children

Child's Name

Date of Birth

Residence

Relationship (biological, adopted, stepchild)

Employment/Schools Attended

For the LAST 5 YEARS, list where you have worked or attended school full or part time. To add another place of employment or schooling, click on the (+) symbol.

Employer/School

City

Dates Employed/In School

Occupation/Field of Study

Required Questions on the N-400

These are some of the questions that are you are required to answer on the N-400 application. They are not the only question, but they are the questions that usually apply to many of my clients.

Have you EVER claimed to be a US citizen (in writing or any other way)?(Required)

Yes

I’m not sure/would like to discuss

Have you EVER registered to vote or voted in any Federal, state, or local election in the United States?(Required)

If you lawfully voted only in a local election where noncitizens are eligible to vote, you may answer “No.”

Yes

I’m not sure/would like to discuss

Do you currently owe any overdue Federal, state, or local taxes in the United States?(Required)

Yes

I’m not sure/would like to discuss

Have you EVER committed, agreed to commit, asked someone else to commit, helped commit, or tried to commit a crime or offense for which you were NOT arrested?(Required)

Do not include minor traffic citations or parking tickets

Yes

I would like to discuss

Have you EVER ever been arrested, cited, detained or confined by any law enforcement officer, military official (in the US or elsewhere), or immigration official for any reason, or been charged with a crime or offense?(Required)

Do not include minor traffic citations or parking tickets

Yes

I would like to discuss

Have you EVER engaged in prostitution, attempted to procure or import prostitutes or persons for the purpose of prostitution, or received any proceeds or money from prostitution?(Required)

Yes

I would like to discuss

Have you EVER been involved in the sale or distribution of illegal drugs?(Required)

Yes

I would like to discuss

Have you EVER been married to more than one person?(Required)

Yes

I would like to discuss

Have you EVER married someone in order to obtain an immigration benefit?(Required)

Yes

I would like to discuss

Have you EVER helped anyone to enter, or try to enter, the United States illegally?(Required)

Yes

I would like to discuss

Have you EVER gambled illegally or received income from illegal gambling?(Required)

Yes

I would like to discuss

Have you EVER failed to support your dependents (pay child support) or to pay alimony (court-ordered financial support after divorce or separation)?(Required)

Yes

I would like to discuss

Have you EVER made any misrepresentation to obtain any public benefit in the United States?(Required)

Yes

I would like to discuss

Have you EVER given any US government officials any information or documentation that was false, fraudulent, or misleading?(Required)

Yes

I would like to discuss

Have you EVER lied to any US government officials to gain entry or admission into the United States or to gain immigration benefits while in the United States?(Required)

Yes

I would like to discuss

Have you EVER applied for any exemption from military service in the US armed forces?(Required)

Yes

I would like to discuss

Provide any comments or questions you have while completing this confidential form

All communications with me are confidential and protected by the attorney-client privilege

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