Summary. Sixteen templates, in the order the case uses them.
1. Eligibility screen worksheet
NATURALIZATION ELIGIBILITY SCREEN
Name: _______________ A-number: _______________
Resident since (from card): ____ / ____ / ______
Five-year eligibility date: ____ / ____ / ______
Earliest filing (minus 90 days): ____ / ____ / ______
Three-year (spouse of citizen) route? Yes / No
Marriage date: ____ / ____ / ______
Spouse citizen since: ____ / ____ / ______
Living in marital union since: ____ / ____ / ______
Three-year eligibility date: ____ / ____ / ______
Earliest filing: ____ / ____ / ______
FLAGS
Any absence >= 6 months? Yes / No Longest: ____ days
Any absence >= 12 months? Yes / No
Any arrest / citation / detention? Yes / No Count: ____
Any unfiled return or balance owed? Yes / No
Any removal proceeding or order? Yes / No
Any prior denial or withdrawal? Yes / No
Selective Service required + missed? Yes / No
Ever claimed U.S. citizenship? Yes / No
Ever registered to vote or voted? Yes / No
ANY FLAG YES -> file review with counsel before filing.
2. Trip log worksheet
TRIP LOG — statutory period ____/____/______ to ____/____/______
# DEPARTED RETURNED COUNTRY DAYS OUT REASON SOURCE
1 __/__/____ __/__/____ ___________ ______ __________ stamp/CBP/other
2 __/__/____ __/__/____ ___________ ______ __________ ______
3 __/__/____ __/__/____ ___________ ______ __________ ______
...
TOTALS
Total days outside U.S. in period: ________
Days in period (5 yr = 1,826 / 3 yr = 1,095): ________
Days physically present (period minus out): ________
Physical presence required (half): ________
Requirement met? Yes / No
Longest single absence: ________ days
>= 180 days? -> rebuttal packet required (Template 3)
>= 365 days? -> continuous residence likely broken; counsel before filing
SOURCES USED
[ ] Passport stamps — all passports, page by page
[ ] CBP travel history request
[ ] Airline / frequent flyer records
[ ] Card and bank statements (foreign transactions)
[ ] Photo metadata
3. Long-absence rebuttal packet cover letter
[Date]
RE: Application for Naturalization — [Name], A-number [____]
Evidence of maintained continuous residence during absence of
[dates], totaling [___] days
To the Adjudicating Officer:
This packet addresses the applicant's absence from the United States from
[date] to [date], a period of [___] days. The applicant did not abandon
residence in the United States during this absence, and submits the
following evidence.
1. Purpose of the absence. [One paragraph — the concrete reason: a
parent's illness, a temporary work assignment, a family obligation.
Attach Exhibit A: (medical records / assignment letter / other).]
2. Employment in the United States was maintained. [Employer name] confirms
that the applicant remained employed throughout the absence and returned
to the same position. Exhibit B.
3. A home in the United States was maintained. The applicant continued to
[own / lease] the residence at [address] throughout the absence, and
[paid the mortgage / paid rent] each month. Exhibits C and D.
4. Immediate family remained in the United States. [Names and relationships,
with addresses.] Exhibit E.
5. Tax returns were filed as a United States resident for [years].
Exhibit F (transcripts).
6. Financial ties were continuous. U.S. bank accounts remained open and
active; statements for the period are at Exhibit G. Driver's license,
vehicle registration, and voter-ineligible identification records
remained current: Exhibit H.
7. No employment was accepted abroad. The applicant did not work for any
foreign employer during the absence and filed no foreign tax return as
a resident of any other country.
The applicant's residence in the United States was continuous throughout
the statutory period.
Respectfully submitted,
[Name] · [Address] · [Phone] · [Email]
EXHIBIT INDEX
A. ______________________
B. ______________________
...
4. Letter requesting a certified disposition
[Date]
Clerk of Court
[Court name and address]
RE: Request for certified copy of disposition
Defendant: [Full name, and any name used at the time]
Date of birth: [____]
Case number: [____] (if known)
Approximate date of arrest / citation: [____]
Charge: [____]
Dear Clerk:
I request a CERTIFIED copy of the complete disposition in the above matter,
including:
- the charging document,
- the final judgment or order of dismissal,
- the sentence imposed, including any suspended portion,
- any order of expungement, sealing, deferred adjudication, or diversion,
- proof of completion of any conditions.
I need a certified copy, with the clerk's seal, for a federal immigration
application. An uncertified printout will not be accepted.
If the record has been expunged or sealed, please provide a certified
statement to that effect, along with any documentation that may be released.
If no record exists for this name and date of birth, please provide a
CERTIFICATION OF NO RECORD.
Enclosed is [$____] for the fee, or please advise the amount and I will
remit promptly.
[Name] · [Address] · [Phone] · [Email]
5. Selective Service explanation statement
SWORN STATEMENT REGARDING SELECTIVE SERVICE REGISTRATION
I, [Name], A-number [____], state under penalty of perjury:
1. I was born on [date] in [country]. I turned 18 on [date] and turned 26
on [date].
2. Between the ages of 18 and 26, my immigration status was:
[dates] — [status]
[dates] — [status]
3. During that period I lived at:
[dates] — [address, country]
[dates] — [address, country]
4. I did not register with the Selective Service System because:
[Choose and complete honestly:]
- I was not living in the United States during that period; or
- I was in the United States in a status that did not require
registration ([status]); or
- I was not aware of the requirement. No one informed me of it. I did not
encounter it in [school enrollment / employment / any application]
during those years, and I first learned of it on [date] when [how].
5. My failure to register was not a knowing and willful refusal to comply
with a legal obligation. I did not intend to evade any duty of service.
6. Attached is the Status Information Letter issued by the Selective Service
System on [date].
7. I have otherwise complied with the laws of the United States. I have
[filed all required tax returns / supported my dependents / maintained
lawful employment] throughout my residence here.
I declare under penalty of perjury that the foregoing is true and correct.
_________________________ Date: __________
[Name]
6. Tax compliance memorandum
MEMORANDUM RE: FEDERAL AND STATE TAX COMPLIANCE
Applicant: [Name], A-number [____]
TAX YEARS IN THE STATUTORY PERIOD
YEAR FILED? FILING STATUS BALANCE OWED CURRENT STATUS
____ Y / N ____________ $ __________ ______________
____ Y / N ____________ $ __________ ______________
...
All returns for the statutory period have been filed. Transcripts for each
year are attached as Exhibit ___.
[If a balance is owed:]
An installment agreement was entered with the Internal Revenue Service on
[date], requiring payments of $____ per month. The agreement is attached as
Exhibit ___. The applicant has made [___] consecutive payments totaling
$______; the account transcript showing those payments is Exhibit ___. The
applicant is current on the agreement and has not defaulted.
[If any late filing occurred:]
Returns for [years] were filed late, on [dates]. The reason was [brief,
factual — a divorce, a serious illness, a period of unemployment, a
misunderstanding of the requirement]. Once the applicant understood the
obligation, all delinquent returns were prepared and filed together.
[If a non-resident return was ever filed:]
The return for [year] was filed on Form ____ as a [status]. This was
[an error by the preparer / a misunderstanding]. The applicant resided in
the United States throughout that year, as shown by [employment records,
lease, school records at Exhibit ___]. An amended return was filed on [date]
correcting the status. Exhibit ___.
[If state taxes apply:]
State returns for [state] for [years] are filed and [paid in full / subject
to a payment plan dated ____].
The applicant has met all federal, state, and local tax obligations, or has
entered and is complying with an agreement to satisfy them.
[Name] Date: __________
7. Fee waiver request cover statement
[Date]
RE: Request for Fee Waiver — Application for Naturalization
[Name], A-number [____]
I request a waiver of the filing and biometrics fees on the following basis:
[ ] MEANS-TESTED BENEFIT. I receive [benefit name] from [agency]. The award
or eligibility letter, dated [date] and covering the current period, is
Exhibit A. My household consists of [__] people: [names, relationships].
[ ] HOUSEHOLD INCOME. My household income is $______ per year for a
household of [__]. This is [__]% of the applicable federal poverty
guideline. Documentation: [most recent federal tax return transcript /
pay statements for the last [__] months / a letter from my employer /
a statement of no income]. Exhibits B through ___.
[ ] FINANCIAL HARDSHIP. [Describe the specific situation: a recent job loss,
a medical emergency, a death in the family, an eviction, extraordinary
expenses. State the amounts and dates.] My monthly income is $______.
My monthly necessary expenses are $______, itemized at Exhibit ___.
Documentation of the hardship is at Exhibits ___ through ___.
I certify that the information above is true and correct.
[Name] · [Address] · [Phone] · Signature ______________ Date ________
8. Disability exception — what the certification must say
Give your physician this page, not a blank form. These are the elements that determine whether the certification is accepted.
GUIDANCE FOR THE CERTIFYING MEDICAL PROFESSIONAL
You must be a licensed medical doctor, doctor of osteopathy, or clinical
psychologist licensed to practice in the United States (or in the territory
where the applicant resides).
The certification must establish ALL of the following. A diagnosis alone is
the most common reason these are rejected.
1. DIAGNOSIS. State the specific condition in clinical terms, with the basis
for the diagnosis (examination findings, testing, records reviewed).
Example structure: "Mr./Ms. [Name] has been under my care since [date].
Based on [examination, testing, records], the diagnosis is [condition]."
2. DURATION. State that the condition has lasted, or is expected to last,
twelve months or longer. Give the onset date.
"This condition has been present since [date] and is expected to be
permanent / to persist indefinitely."
3. THE FUNCTIONAL CONNECTION — the essential element. Explain HOW this
specific impairment prevents this specific person from learning or
demonstrating (a) English, (b) civics knowledge, or (c) both.
Weak, and commonly rejected:
"Patient has [diagnosis] and cannot learn English."
Strong:
"As a result of [condition], Mr./Ms. [Name] has [specific deficit —
e.g., severe impairment of short-term memory consolidation / expressive
and receptive aphasia / a documented intellectual disability with
measured functioning at [level]]. On examination, [he/she/they] is
unable to [retain newly presented factual material beyond a few minutes
/ produce or comprehend sentences of more than [__] words / recall
information presented in a prior session]. [He/She/They] has
participated in [__] months of English instruction at [program] without
measurable progress. In my clinical judgment, [Name] is unable to learn
the English language and unable to retain and recall the civics
material required, and this inability is a direct result of the
diagnosed condition and will not improve."
4. NOT DRUG- OR ALCOHOL-RELATED. State that the impairment is not the result
of the illegal use of drugs.
5. SIGNATURE, license number, license state, specialty, contact information,
and date.
The exemption may be sought for English only, civics only, or both. State
clearly which.
9. Accommodation request
[Date]
RE: Request for Disability Accommodation — Naturalization Interview
[Name], A-number [____], Receipt number [____]
I am requesting the following accommodation(s) for my naturalization
interview and, if approved, my oath ceremony:
[ ] Sign language interpreter ([language])
[ ] Extended time for the examination
[ ] A wheelchair-accessible interview room and building entrance
[ ] Permission for a caregiver or support person to accompany me
[ ] A low-stimulation or quiet room
[ ] Written questions in large print
[ ] An off-site interview and oath, because I am [homebound /
hospitalized / residing in a long-term care facility] at [address]
[ ] Other: ____________________________
The reason for the request is: [brief description of the disability and
what barrier it creates — one or two sentences].
Supporting documentation is attached. [Or: available on request.]
This request is separate from any request for an exemption from the English
or civics requirements.
Please confirm the accommodation before the interview date so that I can
plan accordingly.
[Name] · [Address] · [Phone] · [Email]
10. Interview update sheet
One page. Hand it to the officer at the start.
UPDATES SINCE FILING
Applicant: [Name] A-number: [____] Receipt: [____]
Application filed: [date] · Interview date: [date]
ADDRESSES
[ ] No change since filing
[ ] New address effective [date]: ____________________
Address change reported on [date], confirmation [____]
EMPLOYMENT
[ ] No change
[ ] New employer since [date]: ______________________
Position: ____________ Prior employer ended: [date]
TRAVEL SINCE FILING
[ ] None
[ ] Departed [date], returned [date], [country], [__] days, [reason]
MARITAL STATUS
[ ] No change
[ ] Change: ______________________ effective [date]
CHILDREN
[ ] No change
[ ] New child born [date], name ____________
ARRESTS / CITATIONS SINCE FILING
[ ] None
[ ] [Date, jurisdiction, charge, current status] — certified disposition
attached / pending, obtained on [date]
TAXES
[ ] Current; most recent return filed [date]
[ ] Installment agreement current; [__] payments made since filing
OTHER
______________________________________________________
11. Request for evidence response format
[Date]
RE: Response to Request for Evidence
[Name], A-number [____], Receipt number [____]
RFE dated [date] · Response due [date]
To the Adjudicating Officer:
This is the applicant's complete response to the Request for Evidence dated
[date]. Each item is addressed in the order presented in the request.
ITEM 1 — [Quote or summarize what was requested]
Response: [What is being provided and what it establishes.]
Enclosure 1: ______________________
ITEM 2 — [Requested]
Response: [Provided.]
Enclosures 2(a) through 2(c): ______________________
ITEM 3 — [Requested]
Response: This document cannot be obtained. [Explain what was done:
"I requested this record from [authority] on [date]; the response, at
Enclosure 3(a), states that no record exists / that records from that
period were destroyed." ] In place of it I submit the following secondary
evidence: [list], at Enclosures 3(b) through 3(d).
ENCLOSURE INDEX
1. ______________________
2a. ______________________
...
All enclosures are true copies of documents in my possession; originals are
available for inspection at the interview.
[Name] · [Address] · [Phone] · [Email]
Sent by [method] with delivery confirmation [tracking number]
12. Hearing request on a denial
[Date] FILE WITHIN THE DEADLINE STATED IN THE DENIAL
RE: Request for Hearing on Denial of Naturalization Application
8 U.S.C. § 1447(a)
[Name], A-number [____], Receipt number [____]
Decision dated [date], received [date]
I request a hearing before an immigration officer on the denial of my
application for naturalization.
THE STATED GROUND FOR DENIAL
The decision denies the application on the ground that [quote the exact
ground from the decision].
WHY THE DECISION SHOULD BE RECONSIDERED
[Choose the applicable structure.]
FACTUAL: The decision rests on a finding that [state it]. That finding is
not supported by the record. [State what the record actually shows, with
citations to the evidence.] Enclosed is additional evidence establishing
[what]: [list, Exhibits A through ___].
LEGAL: The decision treats [the conviction under [statute] / the absence
from [date] to [date] / other] as [a bar to good moral character / a break
in continuous residence]. That treatment is incorrect because [set out the
argument, with authority — 8 U.S.C. § 1427, 8 C.F.R. Part 316, and the
relevant case law]. A memorandum of law is enclosed.
EVIDENCE NOT PREVIOUSLY CONSIDERED: The following evidence was [not
requested / not available] at the time of the interview and is submitted
now: [list].
I request that the denial be withdrawn and the application approved, or in
the alternative that the application be reopened for further consideration.
I [do / do not] request that the hearing be scheduled in person.
I [am / am not] represented; representative: ____________________.
[Name] · [Address] · [Phone] · [Email]
Enclosures: [list]
Sent by [method], tracking [____]
13. Delay inquiry — congressional office
[Date]
The Honorable [Name]
Attn: Constituent Services / Immigration Caseworker
[District office address]
RE: Request for assistance — delayed naturalization application
[Name], A-number [____], Receipt number [____]
I am a constituent residing at [address] in [city]. I am writing to request
assistance with a delayed application.
Application filed: [date]
Receipt number: [____]
Biometrics completed: [date]
Interview: [date, or "not yet scheduled"]
Field office: [____]
Published processing time: [__] months
Time elapsed: [__] months
Actions I have already taken:
- Case inquiry submitted [date]; response received [date]: [summary]
- [Other inquiries, with dates and results]
The delay is causing [specific consequence: an expiring travel document, a
pending job requirement, a family petition I cannot file, an inability to
vote in an upcoming election].
I have attached a signed privacy release authorizing your office to inquire
on my behalf.
Thank you for any assistance your office can provide.
[Name] · [Address] · [Phone] · [Email]
Enclosures: privacy release; receipt notice; interview notice; inquiry
responses
14. Post-examination delay — notice before filing suit
[Date]
RE: Application for Naturalization — no decision following examination
[Name], A-number [____], Receipt number [____]
Examination conducted: [date]
Days elapsed since examination: [____]
To the District Director:
My naturalization examination was conducted on [date]. As of today, [___]
days have elapsed and no decision has been issued.
[If applicable: At the examination I was told [what]. I submitted the
requested [documents] on [date]. Delivery confirmation is enclosed.]
Under 8 U.S.C. § 1447(b), where a determination is not made within the
statutory period following the examination, the applicant may apply to the
United States District Court for the district in which the applicant
resides, and the court may either determine the matter or remand it with
appropriate instructions.
I would prefer to resolve this administratively. I request a decision on my
application within thirty days of the date of this letter. If no decision
is issued, I intend to file an action in the United States District Court
for the [District].
[Name] · [Address] · [Phone] · [Email]
cc: [Congressional office] · [Counsel, if any]
Sent by certified mail, return receipt requested, tracking [____]
15. Modified oath request (religious or conscientious objection)
[Date]
RE: Request for Modified Oath of Allegiance — 8 U.S.C. § 1448
[Name], A-number [____], Receipt number [____]
I request to take the oath of allegiance in modified form, omitting the
[bearing arms / noncombatant service] clause(s), on the basis of religious
training and belief.
MY BELIEF
I have been a member of [religious denomination or community], or have held
the following beliefs, since [date]. [Describe the belief in your own
words: what it is, where it comes from, and why it prohibits the conduct in
question. Two or three paragraphs.]
This belief is deeply and sincerely held. It is not based on political,
sociological, or philosophical views, or on a merely personal moral code.
HOW IT HAS BEEN EXPRESSED IN MY LIFE
[Concrete evidence: length of membership, participation, prior
conscientious objection, employment or educational choices made because of
the belief, refusal of prior military service, community service performed.]
SUPPORTING DOCUMENTATION
[ ] Letter from [clergy / religious leader / congregation], Exhibit A
[ ] Membership records, Exhibit B
[ ] Statements from people who know of my belief, Exhibits C–___
[ ] Other: ______________________
I remain willing to [perform work of national importance under civilian
direction / perform noncombatant service], if the law requires it, to the
extent consistent with my belief. I support the Constitution and form of
government of the United States and will bear true faith and allegiance to
them.
[Name] · Signature ______________ · Date __________
16. Derived and acquired citizenship worksheet
DO I OR MY CHILD ALREADY HAVE CITIZENSHIP?
Complete this BEFORE filing a naturalization application.
ACQUISITION AT BIRTH ABROAD
Applicant's date of birth: ____ / ____ / ______
Place of birth: ______________________
Was either parent a U.S. citizen at the time of birth? Yes / No
Parent 1: ____________ Citizen by: birth / naturalization on ________
Parent 2: ____________ Citizen by: birth / naturalization on ________
Were the parents married to each other at the time? Yes / No
U.S. citizen parent's physical presence in the U.S. before the birth:
Dates: ______________________ Total: ______ years
U.S. citizen parent's residence in the U.S. before the birth: ______
NOTE: The requirements changed repeatedly. The rule that applies is the
one in effect ON THE DATE OF BIRTH. Do not use a current chart for an
older birth date. Have this analyzed.
DERIVATION AFTER BIRTH (parent naturalized while the child was a minor)
Child's date of birth: ____ / ____ / ______
Date parent naturalized: ____ / ____ / ______
Child's age on that date: ______
Was the child a lawful permanent resident on that date? Yes / No
Was the child in that parent's legal and physical custody? Yes / No
Was the child residing in the U.S. with that parent? Yes / No
If under 18, LPR, and in the naturalizing parent's legal and physical
custody: citizenship generally attached AUTOMATICALLY, by operation of
law, with no application required.
IF EITHER SECTION SUGGESTS CITIZENSHIP ALREADY EXISTS
[ ] Do NOT file a naturalization application until this is analyzed
[ ] Gather: parents' birth certificates, naturalization certificates,
marriage certificate, the child's birth certificate and green card,
school and medical records establishing custody and residence,
evidence of the citizen parent's U.S. physical presence
[ ] Apply for a certificate of citizenship, or a U.S. passport, or both
[ ] Have the year-specific rule confirmed by counsel
AFTER YOUR OWN NATURALIZATION — YOUR CHILDREN
For each child under 18 on your oath date:
Name: ____________ DOB: ________ LPR? Yes / No
In your legal and physical custody? Yes / No
Residing with you in the U.S.? Yes / No
-> If all yes, the child is likely already a citizen. Document it with
a certificate of citizenship or a U.S. passport while the proof is
easy to assemble.
Related documents
- Naturalization and Citizenship: Eligibility, Good Moral Character, and the Interview
- Applying for Naturalization
- Naturalization Application Checklist
- Family-Based Immigration: Petitions, Priority Dates, and Adjustment of Status
- Personal Income Tax Problems: Unfiled Returns, Liens, Levies, and Offers in Compromise
Templates only, not legal advice. Adapt to your facts and verify current forms, fees, and deadlines. Statutory framework: 8 U.S.C. § 1427 · § 1423 · § 1430 · § 1447 · § 1448 · 8 C.F.R. Part 316.