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Applicant Registration Form/Registración para solicitantes de ciudadanía.
Dominicanos USA (DUSA) offers assistance with the citizenship application, fee waiver, and legal consultation for eligible lawful permanent residents in New York.
Time: 10:00 AM - 1:00 PM
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* Indicates required question
Appointment Time / Hora de cita
*
10:00 AM
11:00 AM
12:00 PM
3:00 PM
4:00 PM
Other:
First name / Primer Nombre
*
Your answer
M.
Your answer
Last Name / Apellido
*
Your answer
What's your age? / ¿Cuál es su edad?
*
18 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65+
Country of origin / Pais de origen
*
Dominican Republic
El Salvador
Mexico
Honduras
Colombia
Jamaica
Other:
Gender / Género
*
Female
Male
Other:
Address / Dirección
Your answer
Apt.
Your answer
City/Ciudad
*
Your answer
State/Estado
*
Your answer
Zip code / Codigo postal
*
Your answer
Phone Number / # de teléfono
*
Your answer
Is this a cell phone #? / ¿Es este un # de celular?
*
Yes/Si
No
Email
Your answer
What is your marital status? / ¿Cuál es su estado civil?
*
Single, Never married/Soltero
Married/Casado
Divorced/Divorciado
Widowed/Viudo
Other:
Required
Do you receive any public benefit? / ¿Recibe algún beneficio público?
*
Medicaid
Food Stamp
Public Housing
SSI
No
Other:
Required
What is your annual household income? / ¿Cual es el ingreso anual de su familia?
Your answer
When did you become a lawful permanent resident? / ¿En que fecha usted obtuvo la residencia?
*
MM
/
DD
/
YYYY
Have you travel outside the U.S. for 6 months or more? / ¿Ha hecho viajes fuera de los EE.UU. por 6 meses o más?
*
Yes / Si
No
Not sure / No estoy seguro/a
Do you have basic knowledge of English language? ¿Tiene conocimiento básico del idioma ingles?
*
Yes/Si
No-Exempt
No
Have you ever not filed your tax returns? / ¿Alguna vez no ha presentado sus declaraciones de impuestos?
*
No
Yes / Sí
Have you ever been arrested, cited, detained or had a MTA ticket? ¿Alguna vez ha sido arrestado, citado, detenido o le han dado una infracción de transito?
*
Yes-Arrested
Yes-MTA
No
Required
Number of NON-citizen children under the age of 18 / Numero de hijos NO- cuidadanos menores de 18 anos de edad
*
Your answer
How did you hear about this event? / ¿Como supo de este evento?
*
Dominicanos USA
Flyer/Volante
Facebook / Instagram
Friend/Amigo
TV/Radio
NALEO
CUNY Citizenship Now!
UFCW
NMCIR
Other:
Required
Are you interested in starting your application at home? ¿Le interesaría empezar su aplicación en casa?
*
Yes/Si
No
Do you feel comfortable using the computer, smartphone or do you have someone to help you? ¿Se siente cómodo usando la computadora, un teléfono inteligente o tiene a alguien que le ayude?
*
Yes/Si
No
N/A
Other:
Would you, a family member or a friend be interested in learning about job opportunities? / ¿Estaría usted, algun familiar o amigo interesado en conocer oportunidades de empleo?
*
Yes / Si
No
Notes
Your answer
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