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]

[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]

[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]

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]

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]

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”]

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]

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]

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]

[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.”]

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]

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

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]