DACA Renewal Application

DACA Renewal Application

This DACA Renewal Application is submitted by Applicant Name: and Representative Name: . The applicant seeks renewal of deferred action and related employment authorization under the applicable deferred action policy and requests consideration in accordance with the program's standards set forth below.

RECITALS

WHEREAS, Applicant previously received deferred action and associated employment authorization and seeks renewal of that deferred action to remain in authorized deferred status; and

WHEREAS, Applicant represents that Applicant continues to satisfy the substantive eligibility criteria for renewal, including representational demonstrations of identity, continuous presence, and absence of disqualifying criminal history; and

WHEREAS, Representative, if any, affirms authority to prepare and sign application materials on behalf of Applicant and agrees to comply with applicable duties in representing Applicant.

NOW, THEREFORE, in consideration of the representations and covenants set forth in this application, Applicant submits the following statements, attestations, and authorizations for renewal review.

1. ELIGIBILITY ATTESTATION

1.1 Applicant attests that Applicant was previously granted deferred action and employment authorization. Date of prior grant: . Expiration of most recent grant: .

1.2 Applicant affirms continuous presence and that there has been no departure, removal, or voluntary departure that would render Applicant ineligible except as fully disclosed in Section 4 below.

1.3 Applicant understands that eligibility is subject to review of the totality of circumstances, including criminal and national security considerations. Applicant acknowledges that material misrepresentation or omission is a ground for denial and may carry civil and criminal penalties.

2. APPLICANT IDENTIFICATION

3. CONTACT AND RESIDENCE

4. IMMIGRATION AND TRAVEL HISTORY

Date of initial deferred action grant applicable to this program: . Has Applicant departed the country since the most recent grant? Yes No

5. CRIMINAL HISTORY AND PUBLIC SAFETY

5.1 Applicant must disclose any arrests, charges, convictions, or participation in criminal activity. Has Applicant ever been arrested, charged, or convicted of a crime? Yes No

5.2 Applicant acknowledges that certain criminal convictions and public-safety-related grounds may make Applicant ineligible for renewal. Applicant authorizes inquiry into criminal history records and understands that adjudicators will evaluate any records in determining eligibility.

6. CERTIFICATION, AUTHORIZATION, AND ATTESTATIONS

6.1 Applicant certifies, under penalty of perjury under the laws of the governing jurisdiction, that the statements in this application are true and correct to the best of Applicant's knowledge and belief. Applicant understands that knowingly and willfully making a false statement or concealing a material fact may result in denial and potential civil or criminal penalties.

6.2 Applicant authorizes disclosure and use of information by appropriate authorities to verify identity, immigration history, criminal history, and national security records. Applicant consents to collection of biometrics, including fingerprints and photographs, if required, and acknowledges these are used for identity verification and background checks.

6.3 Applicant understands that approval of renewal is discretionary and may be conditioned on additional documentation or interviews. Applicant agrees to promptly report material changes in address or contact information during the pendency of the application.

7. PREPARER / REPRESENTATIVE INFORMATION

Preparer certifies that the preparer has assisted in preparing this application, has reviewed it with Applicant, and to the best of preparer's knowledge the information is complete and correct. Preparer acknowledges duty to properly advise Applicant of obligations and consequences of misrepresentation.

8. NOTICES, GOVERNING LAW, AND MISCELLANEOUS

Notices: Any formal notice related to this application shall be effective if mailed to the addresses provided above or delivered in accordance with applicable rules governing notice. Applicant must maintain current contact information and notify authorities of any change as required by law.

Governing Law: This application and all matters arising out of or relating to it shall be governed by and construed in accordance with the laws and procedures applicable to deferred action benefits and associated administrative review processes.

Entire Agreement: This application, together with any attachments, constitutes the entire statement of facts and attestations submitted for consideration and supersedes all prior oral or written statements concerning the same subject matter unless expressly incorporated herein.

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: Any amendment to this application must be in writing and executed by Applicant or Applicant's authorized representative. A waiver of any provision is effective only if in writing.

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

9. ATTACHMENTS

List all supporting documents attached:

ACKNOWLEDGMENT AND SIGNATURES

By signing below, Applicant certifies the truthfulness of all statements made in this application and authorizes the actions described herein, including background checks and biometric collection where required. Representative, if signing below, certifies authority to represent Applicant and affirms the accuracy of information provided by Applicant to preparer.

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