PO BOX 5757
Chicago, IL 60680
VERIFY THE USCIS MAILING ADDRESS BEFORE SENDING, THE ADDRESS ABOVE IS FOR APPLICANTS RESIDING IN NEW YORK STATE.
By Certified Mail Date:
I am writing to request consideration for Deferred Action for Childhood Arrivals (DACA) pursuant to the June 15, 2012 memorandum by Department of Homeland Security Secretary Janet Napolitano. As per the enclosed evidence, I qualify for DACA because:
1. On June 15, 2012 I was [insert age] years old;
2. I have continuously resided in the United States since [insert date of first arrival in the US], up to the present time;
3.I was physically present in the United States on June 15, 2012 and am currently present in the United States;
4. I entered without inspection on [insert date], which is before June 15, 2012, OR
5. My lawful immigration status expired on [insert date], which is before June 15, 2012;
6. I am currently attending [insert name, type, and city/state of school], OR
7. I graduated from [insert name, type, and city/state of school] with a [insert name of degree], OR
8. I obtained a GED on [insert date]; OR
9. I am an honorably discharged veteran of [the US Coast Guard / the US Armed Forces] since [insert date];
10. I have not been convicted of a felony, a significant misdemeanor, or three or more misdemeanors, and do not otherwise pose a threat to national security or public safety,
11. I have been convicted of [insert crime] and was sentenced to [insert sentence], which does not constitute a felony, a significant misdemeanor, or three or more misdemeanors, and I do not otherwise pose a threat to national security or public safety.
In addition to Forms I-821D, I-765, I-765WS, G-1145, two (2) passport-sized photographs, and a check/money order for $465, I am enclosing the following evidence in support of my request:
[Insert list of attached documents]
Thank your for your time and attention to this matter, please do not hesitate to contact me should you require anything further.
Very truly yours
VIA CERTIFIED MAIL AND RETURN RECEIPT
United States Citizenship and Immigration ServicesUSCIS Phoenix Lockbox FacilityP.O. Box 20700Phoenix, AZ 85036-0700(**This is the lockbox facility for certain applicants. Please refer to Step 6, page 2 for the addressthat applies to you**)
REQUEST FOR DEFERRED ACTION FOR CHILDHOOD ARRIVALS
RE:[CLIENT’S NAME] [(DOB: MO/DA/YEAR)]Dear USCIS Officer:Please find enclosed the I-821D Application for Consideration of Deferred Action for ChildhoodArrivals of Mr./Ms. [CLIENT’S FULL NAME] with supporting documentation. Also enclosedare the required I-765 Application for Employment Authorization and the I-765WS Worksheet.Summary[Mr./Ms. LAST NAME] is requesting deferred action as a childhood arrival to the United States,as defined by the USCIS Memorandum issued on June 15, 2012. USCIS Memorandum, J. Napolitano, “Exercising Prosecutorial Discretion with Respect to Individuals Who Came to theUnited States as Children” (June 15, 2012).[Mr./Ms. LAST NAME’s] meets all of the eligibility requirements for deferred action for childhood arrivals [DACA]. Specifically, [Mr./Ms. LAST NAME] is able to prove that [s/he]:1)Entered without inspection before June 15, 2012, or [his/her] lawful immigration statusexpired as of June 15, 2012;2)Is at least 15 years at the time of filing [if not in removal/ordered removed];3)Arrived in the United States before the age of 16;4)Was under the age of 31 on June 15, 2012;5)Has continuously resided in the United States since June 15, 2007, up to the present time;6)Was present in the United States on June 15, 2012; and7)Is currently in school, graduated or received a certificate of completion from high school,obtained a GED, or is an honorably discharged veteran of the Coast Guard or U.S. ArmedForces.The documentation submitted in support of [Mr./Ms. LAST NAME’s] application demonstratesthat [his/her] eligibility pursuant to the requirements above: