I-821D Personal Statement Template: DACA Eligibility & Evidence

I-821D Consideration of Deferred Action for Childhood Arrivals 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 / Lockbox Address for DACA Filings]

Re: Form I-821D, Consideration of Deferred Action for Childhood Arrivals

Personal Statement of [Your Full Name], DOB: [MM/DD/YYYY]

1. Introduction and Purpose of This Statement

I, [Your Full Name], was born on [Date of Birth] in [City, Country]. I submit this personal statement in support of my Form I-821D, Consideration of Deferred Action for Childhood Arrivals.

In this statement, I describe my arrival in the United States as a child, my continuous residence, my education, my family and community ties, and the reasons I am requesting that USCIS grant DACA in my case.

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]

Primary Language(s): [Language(s)]

Parents:

• [Parent’s Name], [Date of Birth], [Citizenship/Nationality], [Current Location/Status]

• [Parent’s Name], [Date of Birth], [Citizenship/Nationality], [Current Location/Status]

Siblings (if any):

• [Sibling’s Name], DOB: [MM/DD/YYYY], [Current Location/Status]

• [Sibling’s Name], DOB: [MM/DD/YYYY], [Current Location/Status]

3. Entry to the United States as a Child

Date of First Arrival in the United States: [MM/DD/YYYY]

Your Age at First Arrival: [Age in Years]

Place of First Arrival: [City, State or Port of Entry]

Manner of Entry: [With Visa / Without Inspection / Other]

If With Visa, Type of Visa: [Visa Type]

Who You Traveled With: [Names and Relationships of People Who Accompanied You]

Brief Description of the Journey:

[Short description of your travel to the United States and your understanding at that time as a child.]

4. Continuous Residence and Physical Presence in the United States

Residence History Since Arrival:

• 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]

Any Departures from the United States Since Initial Entry:

• Date(s) of Departure: [Date(s) or “None”]

• Date(s) of Return: [Date(s)]

• Purpose and Length of Each Trip: [Short Description]

Explanation of Continuous Residence:

[Short paragraph explaining that you have continuously lived in the United States since [Year], including key details that show you consider this your home.]

5. Education History and Current Status

Elementary and Middle School Education in the United States:

• School Name: [Name], City/State: [City, State], Years Attended: [Years]

• School Name: [Name], City/State: [City, State], Years Attended: [Years]

High School Education:

• High School Name: [Name], City/State: [City, State]

• Years Attended: [Years]

• Graduation Date or Expected Graduation Date: [MM/DD/YYYY]

• High School Diploma or GED: [“High School Diploma,” “GED,” or “In Progress”]

College, Vocational, or Other Education (if applicable):

• Institution Name: [Name], City/State: [City, State]

• Program or Major: [Program/Major]

• Dates Attended: [Dates]

• Degree, Certificate, or Credits Earned: [Description]

Current Education Status:

[Description of whether you are currently enrolled, graduated, or planning further education.]

6. Work History and Community Involvement

Work History (if any):

• Employer Name: [Name], City/State: [City, State]

  Position: [Job Title]

  Dates of Employment: [From MM/YYYY to MM/YYYY]

• Employer Name: [Name], City/State: [City, State]

  Position: [Job Title]

  Dates of Employment: [From MM/YYYY to MM/YYYY]

Volunteer and Community Activities:

[Description of any volunteer work, community service, church/temple/mosque/synagogue involvement, school clubs, sports, or other community activities.]

Responsibilities and Contributions:

[Short paragraph describing how you help your family, participate in your community, and contribute positively to life in the United States.]

7. Family, Home, and Ties to the United States

Family Members Living in the United States:

• [Name], [Relationship], [Status if known], [City, State]

• [Name], [Relationship], [Status if known], [City, State]

Home and Daily Life:

[Short description of your daily life, responsibilities at home, and routine with family, school, and/or work.]

Support You Provide to Family:

[Description of childcare, translation, transportation, financial support, or other responsibilities you handle for your family.]

8. Criminal, Juvenile, or Immigration History (If Any)

Criminal or Juvenile History:

• Arrests, Charges, or Convictions: [Description, Dates, Locations, Case Status, or “I have never been arrested, charged, or convicted of any crime.”]

Traffic or Minor Violations:

[Brief list of any traffic tickets or minor infractions, or “None.”]

Immigration History:

• Prior Applications or Petitions: [Form Type – Receipt Number – Date or “None.”]

• Prior Removal, Voluntary Departure, or Immigration Court Proceedings: [Description or “None.”]

Explanation (if there are incidents):

[Short, factual explanation of any incidents, steps taken to address them, and your conduct since that time.]

9. Why I Am Requesting DACA and Positive Discretion Factors

Reasons for Requesting DACA:

[Explanation of why you are requesting deferred action, such as fear of removal, desire to work lawfully, support your family, continue education, and remain in the country you consider home.]

Positive Factors in My Case:

• Length of Residence in the United States: [Number of Years]

• Education and School Effort: [Graduation, grades, attendance, activities]

• Work Ethic and Responsibility: [Employment or responsibilities]

• Community, Religious, or Volunteer Involvement: [Description]

• Family Responsibilities: [Care for children, parents, siblings, or others]

Future Goals and Plans:

[Description of your educational, career, and personal goals if DACA is granted, and how you plan to continue contributing to your family and community.]

10. Supporting Evidence

I am submitting, or will submit, supporting documents with my DACA request that may include:

• Copies of passports, birth certificates, or national identity documents

• School records (report cards, transcripts, diplomas, enrollment letters)

• Evidence of continuous residence (leases, bills, medical records, tax records, pay stubs, letters, or other documents)

• Employment records (if any)

• Records of community or religious involvement

• Court records or police certificates (if applicable)

• Any other documents that support the information in this statement and my eligibility for DACA

11. Closing Declaration

The United States has been my home since I was [Age] years old. My education, friendships, family life, and future plans are here. I respectfully request that USCIS favorably exercise its discretion and grant my request for Deferred Action for Childhood Arrivals.

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-821D 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]