Notes:
1-Please fill out the names as it appears on form I-94.
2-Date of Birth (D.O.B.) MM/DD/YYYY.
3-Place of Birth (P.O.B.) Enter the applicant's country of birth as indicated on form I-94.
4-Primary Language: The applicant's principal spoken language.
5-Relationship: Head of Household, spouse, son, daughter.
6-Pre-exisitng case: If applicant is a member of a current or an existing case, enter the case number. If not, enter N/A.