DACA Advance Parole Application Form

DACA ADVANCE PAROLE APPLICATION FORM

This Advance Parole Application is submitted by Applicant Name: (Applicant) and Representative/Preparer Name: (Preparer), for the limited purpose of requesting parole in accordance with deferred action granted under the Deferred Action for Childhood Arrivals administrative policy.

RECITALS

WHEREAS, Applicant received deferred action under the Deferred Action for Childhood Arrivals policy and seeks permission to travel abroad temporarily by means of Advance Parole; and

WHEREAS, Applicant requests parole for the limited duration and purposes described herein and pledges to comply with all applicable immigration laws and to return to the United States prior to the expiration of the requested parole period; and

WHEREAS, Preparer, if completing this form on behalf of Applicant, certifies under penalty of perjury that the information provided is complete, true, and correct to the best of Preparer's knowledge.

NOW, THEREFORE, in consideration of the mutual acknowledgements below, the parties agree as follows:

1. APPLICANT INFORMATION

2. ADVANCE PAROLE REQUEST

Purpose of Travel (check all that apply):

Humanitarian (emergency medical, funeral, urgent family matter)

Educational (study, research, academic program)

Employment (work-related travel, training)

3. STATEMENT OF FACTS

Provide a concise statement of the facts supporting the request for advance parole. Include dates, locations, and individuals involved. Applicant must attest to the accuracy of these facts.

4. EVIDENCE AND DOCUMENTATION

The Applicant must provide documentary evidence supporting eligibility and the stated purpose. Typical evidence includes but is not limited to the items listed below.

Copy of DACA approval notice or documentation of deferred action

Copy of passport or travel document

Supporting letters, medical records, academic enrollment or employer letters

5. CERTIFICATIONS AND ACKNOWLEDGEMENTS

By signing below, Applicant certifies under penalty of perjury that all information provided in this application and attached documentation is true, correct, and complete. Applicant acknowledges that granting of Advance Parole is discretionary, may be denied, and that parole does not constitute admission, lawful permanent resident status, or guarantee reentry. Applicant understands reentry is subject to inspection and admissibility determinations by immigration authorities at the port of entry.

Applicant further authorizes release of information contained in this application to government agencies and officials as necessary for adjudication of this request and acknowledges that false statements may result in civil or criminal penalties and adverse immigration consequences.

Preparer, if any, certifies that they prepared this application at the request of the Applicant and that the information contained herein is, to the best of Preparer's knowledge, true and correct. Preparer further certifies that they informed Applicant of the penalties for filing false information.

6. NOTICES

All notices and correspondence relating to this application shall be sent to Applicant at the U.S. address provided below unless Applicant designates a different mailing address in writing.

7. MISCELLANEOUS LEGAL PROVISIONS

Governing Law: This Application and any related determinations shall be governed by and construed in accordance with applicable federal immigration laws and regulations and, to the extent not preempted, the laws of the state in which Applicant resides.

Entire Agreement: This form, with the attached statements and documentary evidence, constitutes the entire agreement between the parties regarding the matters set forth herein and supersedes any prior verbal or written representations.

Severability: If any provision of this Application is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

Amendments and Waiver: No amendment or waiver of any provision of this Application shall be effective unless in writing signed by both Applicant and Preparer. Failure to enforce any provision does not constitute a waiver of future enforcement.

Counterparts: This Application may be executed in counterparts, each of which shall be deemed an original but all of which together shall constitute one and the same instrument.

8. PREPARER INFORMATION (IF APPLICABLE)

9. ATTESTATION AND SIGNATURES

The undersigned certify under penalty of perjury under the laws of the United States of America that the information contained in this Application and any accompanying documents is true and correct to the best of their knowledge and belief.

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