I-140 Immigrant Visa Petition Questionnaire

(3 pages)
Name: ______________________________
Date Completed: _____________________
 Please answer each question fully and accurately. We must have full information so that
we can identify any issues and plan your case accordingly.
 Please type directly onto the form, rather than printing it and writing in the information
by hand.

Your full name (Family name in CAPITAL

letters)

Current Address

Email Address

Daytime Telephone Number

Mobile Telephone Number

United States Social Security Number

City of Birth

Province of Birth

Country of Birth

Other Countries of Citizenship (if any)

Your permanent home address outside of the

U.S.. NOTE: This can be a family member’s
address.

Your current immigration status in the U.S.

Date your status will expire (If F-1, date you

will complete your degree or your OPT will
expire)

Has any person or company filed an Immigrant

Visa Petition (I-140 or I-130) on your behalf? If
yes, please provide details and copies of all
USCIS documentation related to your prior
sponsorship

Do you have a CGFNS or FCCPT visa screen?

If you do not have a visa screen, have you passed
an English exam (if required for your visa
screen application)? (We can file an I-140
without a visa screen, but you will need one for the
final green card application step).

Have you ever been arrested or convicted of a

crime?

If you have been arrested or convicted of a

crime, what was the offense?

Have you ever been out of status or had

unauthorized employment?

Have you or any of your dependents ever

received public assistance (for example,
Medicaid, Social Security Income (SSI),
Temporary Assistance for Needy Families
(TANF), Children’s Health Insurance Program
(CHIP), etc.

Have you ever experienced any problems with

US Immigration Service or US Embassies? If
you have experienced any problems with US
Immigration Service or US Embassies, please
provide detailed information and copies of any
related documentation.

If you have a spouse and/or children under the age of 21, please provide the following
information for each family member, even if they will not apply for the Green Card with you.
Please add additional sheet, if necessary.
Full Name (English) First Name:
Middle Name:
Family/Last Name:
Relationship (Spouse/Son/Daughter)
Date of Birth
Country of Birth
Will this person apply for Green Card with you?
(Yes/No)

Full Name (English)- Please write the Surname/ First Name:

Family Name in CAPITAL LETTERS Middle Name:
Family/Last Name:
Relationship (Spouse/Son/Daughter)
Date of Birth
Country of Birth
Will this person apply for Green Card with you?
(Yes/No)

Full Name (English)- Please write the Surname/ First Name:

Family Name in CAPITAL LETTERS Middle Name:
Family/Last Name:
Relationship (Spouse/Son/Daughter)
Date of Birth
Country of Birth
Will this person apply for Green Card with you?
(Yes/No)

Required Documents:
These documents are required to start preparing the I-140 petition. Document copies should be
photocopies or scans; they should not be photos of documents taken with a smart phone or digital camera.
Photographs of documents are not acceptable to U.S. Citizenship & Immigration Services (USCIS).
Please email your documents, rather than uploading them to Dropbox, Google Drive, or other cloud
server.
Please send the questionnaire and document copies all at once, rather than one at a time. That will help
use prepare your petition more quickly and efficiently.
Please send only the documents requested in the list below. We do not need training certificates, driver
licenses, Social Security cards, etc.
Passport identity/biographic page for current, valid passport.
The most recent U.S. visa in your passport.
Your I-94 Departure Record, both front and back sides. Please be sure that the date and place of entry are
legible. If a paper I-94 card was not stapled in your passport when you entered the U.S., you should
access the CPB website (https://i94.cbp.dhs.gov/I94) and PRINT a copy of your I-94.
All Associates, Bachelor’s, Master’s, Ph.D. diplomas in Nursing.
Copies of all transcripts for Associates, Bachelor’s, Master’s, Ph.D. degrees in Nursing. Scanned
unofficial transcripts are sufficient. We do not need original, official transcripts from the university.
NOTE: If you do not have a degree in Nursing awarded by a United States college or university,
we will provide you with detailed instructions to obtain an evaluation of your educational
credentials. Each RN is responsible for the cost of the evaluation (USD $85 - $100).
If you already have a U.S. education equivalency evaluation, please include it with the documents
you send.
Copy of your New York State Registered Nurse License.
Employment Agreement, initialed, signed and notarized.
Check in the amount of $700.00 made payable to U.S. Department of Homeland Security. See
instructions regarding checks.
Important note: You will eventually need a CGFNS VisaScreen (foreign healthcare worker) certificate
to have a green card application approved and become a U.S. Permanent Resident. Unless your Nursing
education was in English, you will probably have to pass an English examination to obtain the
VisaScreen. Please review CGFNS’s requirements at http://www.cgfns.org/services/visascreen/.