Form I-698 - Application To Adjust Status From Temporary To Permanent Resident (Under Section 245a Of The Ina) Page 2

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Part 1. Information About You (continued)
A-
7.
U.S. Physical Address
Street Number and Name
Apt.
Ste.
Flr.
Number
City or Town
State
ZIP Code
8.
Alien Registration Number (A-Number) (if any)
9.
U.S. Social Security Number (if any)
A-
►
►
10.
Date of Birth (mm/dd/yyyy)
11.
Gender
Female
Male
12.
Place of Birth
City or Town
Province or Foreign State
Country
13.
Country of Citizenship or Nationality
14.
Mother's First Name
15. Father's First Name
16.
Marital Status
Single (Never Married)
Married
Divorced or Separated
Widowed
17.
List absences from the United States since becoming a temporary resident. List the most recent absence first. If you have a single
absence that exceeded 30 days or if the total of all of your absences exceeds 90 days, explain using the space provided in Part 8.
Additional Information or attach a separate sheet of paper. Type or print your name and A-Number (if any) at the top of the
sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet.
From
To
Total Days
Country
Purpose of Trip
(mm/dd/yyyy)
(mm/dd/yyyy)
Absent
Part 2. Biographic Information
1.
Ethnicity (Select only one box)
Hispanic or Latino
Not Hispanic or Latino
2.
Race (Select all applicable boxes)
White
Asian
Black or African
American Indian or
Native Hawaiian or
American
Alaska Native
Other Pacific Islander
3.
Height
Feet
Inches
4.
Weight
Pounds
5.
Eye Color (Select only one box)
Black
Blue
Brown
Gray
Green
Hazel
Maroon
Pink
Unknown/Other
6.
Hair Color (Select only one box)
Black
Blond
Brown
Gray
Red
Sandy
White
Bald
Unknown/
(No Hair)
Other
Page 2 of 9
Form I-698 03/03/17 Y

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