Humanitarian Parole Application

HUMANITARIAN PAROLE APPLICATION

Petitioner Name:   Petitioner Address:

Beneficiary Name:   Date of Birth:

Nationality:   Passport/ID Number:   Country of Residence:

Relationship to Petitioner:

RECITALS

WHEREAS, Petitioner seeks humanitarian parole on behalf of Beneficiary to permit temporary entry or continued presence due to urgent humanitarian factors or significant public benefit; and

WHEREAS, Petitioner has provided a factual statement and supporting documentation demonstrating extraordinary circumstances necessitating immediate consideration and temporary relief; and

WHEREAS, Petitioner understands that humanitarian parole is discretionary, limited in duration, subject to conditions, and does not confer immigration status;

NOW THEREFORE, the parties hereby submit the following application and certifications:

1. DEFINITIONS

For purposes of this application: "Parole" means temporary authorization for entry or continued presence, "Beneficiary" means the person for whom parole is sought, and "Petitioner" means the individual or entity submitting this application. References to statutes or regulations are illustrative of applicable standards and do not create new rights.

2. NATURE OF PAROLE REQUESTED

Petitioner requests humanitarian parole for Beneficiary for the following primary reason(s). Petitioner affirms that the circumstances are urgent and require temporary entry or continued presence:

Medical emergency or need for critical treatment
Family unity to reunite with immediate family for urgent reasons
Evacuation due to armed conflict, natural disaster, or humanitarian crisis
Significant public benefit (specific project or assistance)

3. STATEMENT OF FACTS

Provide a clear, chronological statement explaining the emergency circumstances, and explain why other remedies or travel options are not available or appropriate.

4. REQUESTED PERIOD OF PAROLE

Proposed start date:   Proposed end date:

5. SUPPORTING DOCUMENTS

The petitioner submits the following supporting documentation. Check each item provided and attach copies where applicable.

Medical records, physician letters, and treatment plans
Copy of Beneficiary passport or identity document
Evidence of relationship (birth certificate, marriage certificate, affidavits)
Evidence of conditions in country of origin (news clippings, affidavits)
Evidence of financial support or sponsorship arrangements

6. CONDITIONS OF PAROLE

If parole is granted, Beneficiary agrees to comply with all conditions imposed, including but not limited to: reporting requirements, limitations on employment unless authorized, cooperation with any monitoring or biometric collection, and departure at the end of the authorized parole period. Petitioner acknowledges responsibility to ensure Beneficiary's compliance with such conditions.

7. REPRESENTATIONS, WARRANTIES AND CERTIFICATIONS

Petitioner certifies under penalty of perjury that all information submitted in support of this application is true, complete, and correct to the best of Petitioner's knowledge. Petitioner acknowledges that knowingly making a false statement or submitting false evidence may subject Petitioner and Beneficiary to civil and criminal penalties and may result in denial of this application and future immigration consequences.

Petitioner further authorizes disclosure and use of information provided herein to agencies and officials involved in the review of this application for purposes directly related to adjudication, and for law enforcement or national security purposes as required by law.

8. FEES, COSTS AND THIRD-PARTY SERVICES

Petitioner acknowledges responsibility for any fees, costs of transportation, medical care, monitoring, or other expenses arising from grant of parole. Use of an attorney or representative is optional and does not affect the discretionary nature of parole.

9. NOTICES

All official notices concerning this application will be sent to the addresses below unless updated in writing.

10. AMENDMENT, WAIVER AND COUNTERPARTS

This application may be amended by written notice signed by Petitioner. No waiver of any provision is effective unless in writing and signed. This application may be executed in counterparts, each of which is an original and together constitute one instrument.

11. GOVERNING LAW, ENTIRE AGREEMENT, SEVERABILITY

Governing Law: This application and any determinations relating to the discretionary grant of parole shall be governed by applicable federal law and regulations. Entire Agreement: This application, including attachments and incorporated documents, constitutes the entire submission regarding the request for humanitarian parole and supersedes prior communications on the same subject. Severability: If any provision is found unenforceable, the remainder shall remain in full force and effect.

12. ACKNOWLEDGMENT AND SIGNATURES

By signing below, Petitioner and Beneficiary each certify that the information provided in this application is true and accurate under penalty of perjury, and agree to comply with any conditions imposed in the event humanitarian parole is granted.

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