Asylum Adjustment of Status Form

Asylum Adjustment of Status Form

This Asylum Adjustment of Status Application is submitted by Applicant Name: (hereafter "Applicant") and completed with the assistance or representation of Authorized Representative Name: (hereafter "Representative"). Applicant Alien Number (A-Number): . Date of filing: .

RECITALS

WHEREAS, Applicant was granted asylum status on or about and has maintained continuous presence since the date of asylum grant; and

WHEREAS, Applicant seeks adjustment of status to that of lawful permanent resident pursuant to applicable immigration statutes and regulations, and submits this form together with supporting evidence demonstrating eligibility and admissibility; and

WHEREAS, Representative is authorized by Applicant to prepare, review and file this Application and to receive notices on Applicant's behalf as set forth below.

NOW THEREFORE

In consideration of the mutual covenants and representations contained herein, Applicant and Representative agree as follows:

1. APPLICANT IDENTIFICATION

2. ELIGIBILITY STATEMENT

Applicant affirms that Applicant satisfied the statutory requirements for adjustment based on asylum including continuous presence, maintenance of asylum status, and admissibility under relevant immigration law as of the date of this filing. Applicant states the principal basis for adjustment is:

3. SUPPORTING DOCUMENTATION

Applicant submits the following documents in support of this Application (check all that apply and attach copies):

4. BACKGROUND, INADMISSIBILITY AND WAIVERS

Applicant must disclose any criminal history, prior immigration violations, or grounds of inadmissibility. Failure to disclose material facts may result in denial and adverse immigration consequences.

If Applicant is subject to a ground of inadmissibility, Applicant must indicate whether a waiver is being requested and attach a statement of reasons and supporting evidence.

5. BIOMETRICS, MEDICAL EXAMINATION AND INTERVIEWS

Applicant acknowledges that biometric collection, medical examinations, and a personal interview may be required. Applicant hereby authorizes release of medical records and submission of required biometrics.

6. REPRESENTATION AND AUTHORIZATIONS

Representative certifies that they are authorized to prepare and submit this Application and to accept service of process and correspondence on Applicant's behalf. Representative must disclose any conflicts of interest and provide contact information.

7. NOTICES

Any notice required or permitted under this Application shall be in writing and shall be deemed given when delivered in person, sent by certified mail to the address provided above, or transmitted to the email address provided above. Notices to Representative shall be effective when sent to the Representative contact provided above.

8. FEES AND COSTS

Applicant acknowledges responsibility for any required filing fees, medical examination fees, biometric fees, and any fees charged by Representative. Payment of fees does not guarantee approval.

9. CERTIFICATION UNDER PENALTY OF PERJURY

I certify, under penalty of perjury under the laws applicable to this Application, that I have examined this form and the accompanying documents and that, to the best of my knowledge and belief, they are true, correct, and complete. I understand that making a false statement or submitting fraudulent evidence may subject me to criminal and civil penalties, including denial of the Application and removal from the United States.

10. AMENDMENTS; WAIVER

This Application may be amended in writing by Applicant with notice to Representative. No waiver of any provision of this Application is effective unless in writing and signed by the party granting the waiver.

11. GOVERNING LAW

This Application and any disputes arising under it shall be governed by the immigration laws of the United States and by the applicable federal statutes and regulations. Venue for any judicial proceedings related to this Application shall lie in the appropriate federal court having jurisdiction.

12. ENTIRE AGREEMENT; SEVERABILITY; COUNTERPARTS

This Application, including all attachments and declarations, constitutes the entire understanding between Applicant and Representative with respect to the subject matter. If any provision of this Application is held invalid or unenforceable, the remaining provisions shall remain in full force and effect. This Application may be executed in counterparts and facsimile or electronic signatures shall be deemed original for all purposes.

13. ACKNOWLEDGMENT

By signing below, Applicant attests that all information provided here is true and complete and authorizes Representative to act on Applicant's behalf as described above.

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