Citizenship Assistance Form – The American Place

If you’re seeking assistance with your Citizenship Application Form (N-400) or wish to enroll in a class please complete this form.

- Step 1 of 4

I need assistance with *

My application
Registering for a Citizenship Class ONLY
Both

1. Name *

First

Middle

Last

2. PHONE *

3. Email *

4. I am at least 18 years old *

Country of birth

Green Card resident since date *

Green Card expiration date *

6. I have been a Permanent Resident for at least 5 years (3 years if married to a U.S. Citizen) *

Yes
No
Not sure

7. During the last 5 years (3 years if married to a U.S. citizen), have you travelled outside of the U.S. frequently OR taken a trip that lasted one year or more? *

Yes
No
Not sure

9. Applicants must be a person of good moral character (GMC) including, owing no taxes, providing child support; having no outstanding traffic tickets, etc.. Certain types of criminal conduct automatically prevents applicants from establishing GMC. Our Immigration Counselors will assess an applicant’s GMC and determine if they meet or lack GMC before preparing and submitting an application. I am a person of good moral character *

Yes
No
Not sure. Prefer to consult with an Immigration Counselor

10. I have lived in CT for three months or more. *

11. MEN ONLY: I have been in the U.S. between the ages of 18 and 26 and registered with the Selective Service. If you are not sure, click here to register or confirm that you are registered https://www.sss.gov/Registration-Info

Yes
No
Not sure
I am not Male

KNOWLEDGE OF ENGLISH

The most common reason for applicants failing the Naturalization Interview is their lack of English skills. Applicants requesting assistance at The American Place must first demonstrate an intermediate level of proficiency in reading, writing, and spoken English by participating in an English language interview. Those clients whose English meets the required proficiency level may begin their application process and register for Citizenship class. Applicants needing further English support are recommended to attend the Library’s free English program.

I have studied English previously *

Basic
Intermediate
Advanced

English language exemption

Applicants may be exempt from the English language requirements for citizenship if you are age 50 or older, and have lived in the U.S. for 20 years, OR, 55 or older and have lived in the U.S. for 15 years. Please respond to the questions below if you think you may be exempt.

I am at least 50 years old and I have been a legal permanent residency (Green Card holder) for at least 20 years

I am at least 55 years old and I have been a legal permanent residency (Green Card holder) for at least 15 years

DOCUMENT CHECKLIST: Before we can schedule an appointment with a Legal Counselor please verify that you can produce these documents

Green Card *

CT State ID OR CT Driver’s License *

Current passport from your country. NOTE: If you are a REFUGEE or ASYLEE a copy of your I-94 Travel Document will suffice. *

Yes
No
I have a I-94

Tax returns (1040 or 1040 EZ; NOT your W4 forms) for last 5 years OR last 3 if filing on the bases of marriage to a US citizen. NOTE: As long as the counselor has the household’s MOST RECENT TAX FORMS the initial consultation may proceed while you collect the previous tax transcripts. You may request a copy of your tax transcripts online at https://www.irs.gov/individuals/get-transcript *

Court disposition for any criminal offense committed in the United States or abroad, regardless of whether the arrest resulted in a conviction. To get your disposition, you will need to go to the court where you were heard, see the clerk (typically the criminal clerk if you are given a choice), and ask for a certified disposition of your case. The clerk will need your identification which should include your name and date of birth. Assuming that the clerk finds something, s/he may require $5-$10 for the certification. *

Yes
No
Does not apply to me

In the box below please list past 5 years of employment. Include the name of the Employer / Address/ Start Date / End Date *

In the box below please please List Past 5 years of residency. Include Address / City / State / Date moved in / Date moved out *

APPLICANTS WITH CHILDREN. If you do not have children please just check off "Does not apply to me."

Birth Certificates of your children under 22 years old, born AFTER you received your green card. *

Yes
No
Does not apply to me

Proof of child support for children 18 years old or younger, that DO NOT RESIDE WITH YOU *

Yes
No
Does not apply to me

Please provide the following information in the box below. Include every child and step child regardless of age. Note: You will need to provide your childs Green Card number at your meeting. Name/Address/Date of birth/Country of birth

APPLICANTS MARRIED/DIVORCED/WIDOWED. If you've never been married please just check off "Does not apply to me."

Marriage Certificate(s) for every marriage. Note: If you cant find your marriage certificate but have your divorce certificate that will suffice. *

Yes
No
Does not apply to me

Naturalization Certificate of current spouse if spouse is a US citizen *

Yes
No
Does not apply to me

Divorce Decree(s) for every divorce or Death certificate *

Yes
No
Does not apply to me

Marriage and Divorce/Death Certificate of your spouse’s prior marriage(s) *

Yes
No
Does not apply to me