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I-821 Application for Temporary Protected Status Personal Statement Template
Clearly explain your TPS story, continuous presence, and reasons you qualify for Temporary Protected Status.
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I-821 Application for Temporary Protected Status Personal Statement Template
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I-821 Application for Temporary Protected Status Personal Statement Template
[Your Full Name]
[A-Number (if any)]
[Your Street Address]
[City, State, ZIP Code]
[Phone Number]
[Email Address]
[Date]
U.S. Citizenship and Immigration Services
[USCIS Service Center / TPS Address]
Re: Form I-821, Application for Temporary Protected Status
Personal Statement of [Your Full Name], DOB: [MM/DD/YYYY]
1. Introduction
I, [Your Full Name], was born on [Date of Birth] in [City, Country]. I am submitting this personal statement in support of my Form I-821, Application for Temporary Protected Status.
In this statement, I provide information about my background, my connection to [TPS-Designated Country], my residence in the United States, and my concerns about returning to [Country] at this time.
2. Personal Background
Full Name: [Your Full Name]
Other Names Used: [Other Names or “None”]
Date of Birth: [MM/DD/YYYY]
Place of Birth: [City, Country]
Citizenship/Nationality: [Country]
Ethnic Group (if relevant): [Ethnic Group or “N/A”]
Religion or Belief System (if relevant): [Religion / Belief or “N/A”]
Primary Language(s): [Language(s)]
Education: [Schools Attended and Highest Level of Education]
Occupation in Home Country: [Job Title / Main Work Activities]
3. Family Background
Parents:
[Parent’s Name], [Date of Birth], [Citizenship / Current Location]
[Parent’s Name], [Date of Birth], [Citizenship / Current Location]
Spouse or Partner (if any):
Name: [Spouse/Partner Name]
Date of Birth: [MM/DD/YYYY]
Citizenship/Nationality: [Country]
Current Location and Status: [Location / Status]
Children (if any):
[Child’s Name], DOB: [MM/DD/YYYY], [Country of Birth], [Current Location and Status]
[Child’s Name], DOB: [MM/DD/YYYY], [Country of Birth], [Current Location and Status]
Other Close Family Members:
[Names, relationships, and current locations of siblings, grandparents, or other important relatives.]
4. Connection to the TPS-Designated Country
Country for TPS: [Country Name]
Place of Upbringing: [City/Town, Region, Country]
How Long You Lived There: [Years]
Family and Community Ties in [Country]:
[Short description of your family, community, or work life in the TPS-designated country.]
Any Previous Moves Within [Country]:
[Description of major internal moves or relocations, with approximate dates.]
5. Entry to the United States and Immigration History
Date of Last Departure from [Country]: [Date]
Countries Transited Before the United States (if any): [Countries / “None”]
Date of Arrival in the United States: [Date]
Place of Arrival: [City, State or Port of Entry]
Manner of Entry: [With Visa / Visa Waiver / Without Inspection / Other]
Class of Admission (if any): [Class of Admission or “N/A”]
Immigration History in the United States:
Prior Applications or Petitions Filed: [Form Type – Receipt Number – Date or “None”]
Prior Removal, Voluntary Departure, or Immigration Court Proceedings: [Description or “None”]
6. Residence and Presence in the United States
Current Address: [Street, City, State, ZIP Code]
Residence History in the United States:
From [MM/YYYY] to [MM/YYYY]: [Address, City, State]
From [MM/YYYY] to [MM/YYYY]: [Address, City, State]
From [MM/YYYY] to Present: [Address, City, State]
Employment, Study, or Other Activities in the United States:
[Description of work, school, or other significant activities, with approximate dates.]
Departures from the United States (if any):
Date(s) of Departure: [Date(s) or “None”]
Date(s) of Return: [Date(s)]
Purpose of Travel: [Short Description]
7. Conditions in the TPS-Designated Country
General Conditions in [Country]:
[Short description of conflict, disaster, or other extraordinary and temporary conditions affecting your country.]
Conditions in Your Home Region or City:
[Description of how these conditions affect your specific area, such as security, infrastructure, economy, or basic services.]
Effects on You and Your Family:
[Description of how conditions in the country impact your safety, access to work, health care, housing, education, or daily life.]
8. Reasons You Are Applying for TPS
Reasons You Cannot Safely or Reasonably Return to [Country] at This Time:
[Description of your concerns about returning, including safety, violence, disaster-related issues, or severe disruptions in basic living conditions.]
Impact on Your Family if You Must Return:
[Description of how your return would affect you, your spouse, children, parents, or other close relatives, both in the United States and abroad.]
Any Prior Harm or Threats in [Country] (if applicable):
[Brief description of any specific incidents of harm, threats, or serious problems you personally experienced.]
9. Life in the United States
Current Household Members in the United States:
[Names, relationships, and immigration or citizenship status, if known.]
Work and Community Involvement:
[Description of your work, volunteering, religious or community participation, and support you provide to family or community members.]
Responsibilities and Support You Provide:
[Description of childcare, elder care, financial support, or other important responsibilities you have in the United States.]
10. Hardship If TPS Is Not Granted
Potential Hardship to You:
[Description of how denial of TPS would affect your safety, health, livelihood, and access to basic needs.]
Potential Hardship to Your Family:
[Description of hardship to your spouse, children, or other close relatives in the United States or abroad if you must return or if you cannot lawfully remain or work.]
11. Supporting Evidence
I am submitting, or will submit, supporting documents with my Form I-821, which may include:
Copy of my passport or national identity document from [Country]
Birth certificate or other civil documents
Entry and travel documents (visa, I-94, tickets, or other records, if available)
Proof of residence in the United States (leases, bills, school records, employment records, tax records, or other documents)
Documents about conditions in [Country] (reports, news articles, or other reliable information)
Documents about my family relationships and responsibilities (marriage certificates, birth certificates of children, affidavits, or letters)
12. Closing Declaration
I respectfully request that USCIS approve my Form I-821, Application for Temporary Protected Status. I wish to remain lawfully in the United States during the period that [Country] is designated for TPS so that I can live and support myself and my family without being returned to dangerous or unstable conditions.
I declare under penalty of perjury under the laws of the United States of America that the information in this personal statement and in my Form I-821 and supporting documents is true and correct to the best of my knowledge and belief.
Executed on [Day] [Month], [Year], in [City, State].
[Your Full Name]
[Signature, if printed]
[Date]
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Learn more about
I-821 Application for Temporary Protected Status Personal Statement Template
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
I-821 APPLICATION FOR TEMPORARY PROTECTED STATUS PERSONAL STATEMENT TEMPLATE FAQ
What is Form I-821, Application for Temporary Protected Status?
Form I-821 is the official USCIS form used by eligible individuals to apply for Temporary Protected Status (TPS) or to re-register for TPS. TPS is a temporary immigration status for nationals of certain designated countries (or people with no nationality who last habitually resided there) when returning safely to that country is not possible due to armed conflict, environmental disaster, or other extraordinary conditions.
Who can apply for TPS using Form I-821?
You may be eligible to apply for TPS on Form I-821 if you are a national of a country that has been designated for TPS (or last habitually resided there if you have no nationality), you meet the required continuous residence and continuous physical presence dates for that designation, and you are not barred from TPS by certain criminal, security, or other grounds. Each TPS designation has its own specific requirements and deadlines.
What is the purpose of an I-821 TPS personal statement?
An I-821 TPS personal statement is a written declaration that you submit with your TPS application. It helps you clearly explain your personal background, nationality, entry and stay in the United States, continuous residence and physical presence, any prior immigration or criminal history, and how conditions in your home country affect you. The statement supports the answers you give on Form I-821 and the documents you provide, but it does not replace the official form or its instructions.
What should I include in my TPS personal statement?
You should usually include: your identity and nationality; a short description of your life and family; the dates, places, and manner of your entry into the United States; how you have lived continuously in the U.S. since the required dates; how often and why you have (or have not) left the U.S.; any immigration or criminal history that may be relevant; and a brief explanation of why it is unsafe or unrealistic for you to return to your home country while the TPS designation is in place. Your statement should be honest, specific, and consistent with your forms and supporting evidence.
Does this TPS template give legal advice or replace the official I-821 form?
No. This template is only a sample format to help you organize your own personal declaration in support of Form I-821. It does not replace the official I-821 form, the official USCIS instructions, Federal Register notices, or legal advice from a qualified immigration attorney or accredited representative. TPS rules and designations can change, so you should always rely on the latest official guidance and professional advice for your specific case.
Can AI Lawyer help me with my I-821 TPS personal statement?
Yes. AI Lawyer can help you use this I-821 TPS personal statement template by suggesting clearer wording, improving structure, and helping you present your history and country-conditions story in a more organized, readable way. You still need to provide the true facts, documents, and final decisions about what to include, and AI Lawyer does not replace a licensed immigration attorney or guarantee any outcome. However, it can save time, reduce stress, and help you create a more polished TPS declaration to review with a qualified professional.
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