Completed sample USCIS Form I-821D

Update on June 5, 2014:  The information below is outdated since the USCIS changed this form.  Please use the completed sample example of the latest USCIS Form I-821D instead.

In order to receive a work permit by DREAMers, one of the three forms that they have to file is USCIS Form I-821 D and the purpose of this form is to assess if they are eligible for deferred action for childhood arrivals.  Here are some helpful tips and suggestions along with examples of answers.
  1. For Part 1, Information About You, pull out your passport and birth certificate, and complete the questionnaire as accurately as possible in black ink or type it out online and then print it in black and white.  The mailing address should be the one where you currently live or some place where you can definitely receive your mail, because this is the address to which the USCIS will mail all letters.  If you live somewhere you are not confident that all your mail will be delivered to you, provide an address where someone who cares for you.  Even better, get a post office box somewhere for the duration of this process so that your mail will not be displaced.  The last thing you want to have is lost mail from USCIS.  As far as removal proceedings are concerned, I am assuming that the answer is NO, because if the answer is YES, I would expect you to use an attorney to do your paperwork.

    Information about you section of form i821d
  2. For question number 4, if you were ever assigned an A#, complete it.  This number is generally provided to applicants for immigrant visas.  If not, leave it blank.  Similarly, if you have a social security number (even if it does not authorize to work and you have never worked using it), provide it here.  If you have used a fake SSN or that of someone else, consult an attorney because this is a serious crime and could be grounds for rejection of your application (it is likely that at some point USCIS may clarify this issue and give guidance on what it intends to do in such cases, or alternatively, you can wait to find out what happens to those applicants who are applying either by not providing this information or admitting to a crime).  If you simply do not have one, leave it blank.  Questions 6 to 11, are straightforward, and make sure that for country of residence, you pick the United States, because that is where you should be living in order to be qualify (the simple definition of 'country of residence' is whatever country you have been living for some time even if you are not here legally; in this case, it is the US -- your nationality tells the authorities where you are legally a citizen of).  Regarding other names used, this is your chance to provide if you have more than three names or your names were switched or you changed names after marriage, or if there are spelling differences in your names on your passport/birth certificate/high school certificates.  Provide further explanation later on if it is still confusing. 
  3. Starting from items 13 to 17, enter your date of entry into the US, even if you are not sure about the exact date.  Enter the airport or land crossing name if you entered with inspection, otherwise, enter the name of the town closest to the border crossing if you simply crossed without inspection.  In #14, pick the category that your I-94 has; otherwise, pick entry without inspection if you simply crossed the border illegally.  If you have Form I-94, enter the information, and if you have lost it, leave it blank, but provide an explanation at the end.  Filling education details should be simple and straightforward and you should have correct documents to prove your education credentials.  If you ever served in the military, get your file out and enter all the details.
  4. In Part 2, arrival/residence information, you will hopefully answer YES to both, if not, you might need to discuss your case with a lawyer.  Or you might not be eligible to apply.  So make sure that you under eligibility requirements for deferred action for childhood arrivals.  Under present address, provide your address where you live, even if it is different from your mailing address you provided earlier.  If you have ever lived at any other places, provide all those addressed going all the way back to your initial entry.  Do not stop at June 2007.  You need to include each and every single address unless you were there for days/weeks.  Regarding departures from the US, again, I am hoping that you do not have any departures, because if you do, you better seek legal advice.
  5. In part 3, criminal, national security and public security information, I expect that you will answer NO to all five questions.  Remember that speeding/parking tickets do not count, but if you have had trouble with the law, speak to a legal professional first.

  6. In part 4, since you are filling the application yourself, pick 1(a), date and sign your name, and provide a telephone number that either you will answer or someone who speaks English can take a message.  Make sure that you have voice-mail or answering machine on this number so that someone can leave a message.
  7. Part 5 and 6 are not meant for anyone completing the application on his/her own and if you are using a professional to fill it or using an interpreter, they will fill it, and that is why it is not valid for this article.
  8. Part 7 is to be used to provide additional information to each and every question above.  Use it effectively.  Basically, if you want to provide new information for any item, then go back to that item in the form, copy its page number, part number, and item number and fill it here.  Then in the blank space provide the information in detail.  So for example, you want to talk about how you also had a nickname and some of your certificates that prove a bunch of things about you are in your nickname, that can be stated here.  In yet another example, you may add in item 2a, page 4, in 2b, you provide, part 3, which is about criminal/safety, and then in 2c, you provide the item number, for example, 5c, and then in 2d, you can explain this point by saying that, for instance, you were once involved in beating up someone when you were a teenager because you belonged to a group of bad friends.  If you want to add even more addresses in the US, in 2a, 2b, 2c, and 2d respectively, you will put 3, 2, 5, and then in 2d, put the address(es.)
    Sample filled part 7 of USCIS form i821