Form I-687 - Application For Status As A Temporary Resident Under Section 245a Of The Immigration And Nationality Act Page 7
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9I am a male over the age of 17 and under the age of 26 required to register under the Military Selective Service Act and have
not done so. I wish to register at this time. My SSS Form 1 is attached.
I am a male born after 1959 and over the age of 26 and cannot now register.
I am exempt from Selective Service Registration either because I am a female or I was born before 1960.
35. Have you ever assisted in the persecution of any person or persons on account of race, religion, political
Yes
No
opinion, nationality, or membership in a particular social group?
36. Have you ever been treated for a mental disorder, drug addiction, or alcoholism?
Yes
No
37. Have you ever committed a crime or offense for which you were not arrested?
Yes
No
Have you ever been arrested, cited, or detained by any law enforcement
Yes
No
officer (including USCIS or former INS and military officers) for any reason?
Have you ever been charged with committing any crime or offense?
Yes
No
Have you ever been convicted of a crime or offense?
Yes
No
Yes
No
Have you ever been in jail or prison?
Have you ever been placed in an alternative sentencing or a rehabilitative program
Yes
No
(for example: diversion, deferred prosecution, withheld adjudication, deferred adjudication)?
Have you ever received a suspended sentence, been placed on probation, or been paroled?
Yes
No
If you answered "Yes" to any of Number 37, complete the following table. If you need more space to complete, use a separate
sheet of paper. Write your name and Alien Registration Number (A-Number), if any, at the top of each sheet of paper and
indicate on the sheet that the information refers to Number 37.
Date arrested, cited,
Where were you arrested,
Why were you arrested, cited, detained,
Outcome or disposition of the arrest,
detained, or charged
cited, detained, or charged?
or charged?
citation, detention, or charge
(mm/dd/yyyy)
(City, State, Country)
Attach all certified police reports, indictments, and certified court dispositions for any arrests, citations, detentions,
charges, or imprisonment.
38. Have you, or a dependent member of your immediate family, ever received public assistance from
Yes
No
any source, including, but not limited to, the United States Government, any state, county, city, or
municipality?
39. Have you ever:
Within the past 10 years been a prostitute or procured anyone for prostitution, or intend to engage in
Yes
No
such activities in the future?
Yes
No
Engaged in any unlawful commercialized vice, including, but not limited to, illegal gambling?
Yes
No
Knowingly encouraged, induced, assisted, abetted, or aided any alien to try to enter the United States
illegally?
Form I-687 (11/23/10) Y Page 7
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