USCIS Form I-941 "Application for Entrepreneur Parole"

USCIS form I-941 is a U.S. Department of Homeland Security - Citizenship and Immigration Services form also known as the "Application For Entepreneur Parole". The latest edition of the form was released in December 22, 2017 and is available for digital filing.

Download an up-to-date fillable USCIS Form I-941 in PDF-format down below or look it up on the U.S. Department of Homeland Security - Citizenship and Immigration Services Forms website.

Step-by-step Form 941 instructions can be downloaded by clicking this link.

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Download USCIS Form I-941 "Application for Entrepreneur Parole"

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USCIS
Application for Entrepreneur Parole
Form I-941
Department of Homeland Security
OMB No. 1615-0136
U.S. Citizenship and Immigration Services
Expires 01/31/2019
Receipt
Action Block
For
USCIS
Use
Only
Remarks
Select this box if
Attorney State Bar Number
Attorney or Accredited Representative
To be completed by an
Form G-28 or
(if applicable)
USCIS Online Account Number (if any)
attorney or accredited
G-28I is attached.
representative (if any).
START HERE - Type or print in black ink.
Part 1. Information About the Entrepreneur
Other Names Used
(Applicant)
Provide any other names you have used since birth, including
I am requesting:
aliases, maiden names, and nicknames. If you need extra space
to complete this section, use the space provided in Part 10.
1.a.
Initial Parole
Additional Information.
OR
4.a. Family Name
1.b.
Re-Parole
(Last Name)
OR
4.b.
Given Name
(First Name)
1.c.
Amended Application
4.c.
Middle Name
If you are requesting a re-parole or filing an amended application,
provide the Receipt Number of your current Form I-941 approval
in Item Number 2. below.
Other Information
2.
Receipt Number
5.
Alien Registration Number (A-Number)
A-
6.
USCIS Online Account Number (if any)
Your Full Name
3.a. Family Name
(Last Name)
7.
U.S. Social Security Number (if any)
3.b.
Given Name
(First Name)
3.c.
Middle Name
8.
Date of Birth (mm/dd/yyyy)
9.
Sex
Male
Female
10.
Marital Status
Single
Married
Divorced
Widowed
Form I-941 12/22/17 N
Page 1 of 15
USCIS
Application for Entrepreneur Parole
Form I-941
Department of Homeland Security
OMB No. 1615-0136
U.S. Citizenship and Immigration Services
Expires 01/31/2019
Receipt
Action Block
For
USCIS
Use
Only
Remarks
Select this box if
Attorney State Bar Number
Attorney or Accredited Representative
To be completed by an
Form G-28 or
(if applicable)
USCIS Online Account Number (if any)
attorney or accredited
G-28I is attached.
representative (if any).
START HERE - Type or print in black ink.
Part 1. Information About the Entrepreneur
Other Names Used
(Applicant)
Provide any other names you have used since birth, including
I am requesting:
aliases, maiden names, and nicknames. If you need extra space
to complete this section, use the space provided in Part 10.
1.a.
Initial Parole
Additional Information.
OR
4.a. Family Name
1.b.
Re-Parole
(Last Name)
OR
4.b.
Given Name
(First Name)
1.c.
Amended Application
4.c.
Middle Name
If you are requesting a re-parole or filing an amended application,
provide the Receipt Number of your current Form I-941 approval
in Item Number 2. below.
Other Information
2.
Receipt Number
5.
Alien Registration Number (A-Number)
A-
6.
USCIS Online Account Number (if any)
Your Full Name
3.a. Family Name
(Last Name)
7.
U.S. Social Security Number (if any)
3.b.
Given Name
(First Name)
3.c.
Middle Name
8.
Date of Birth (mm/dd/yyyy)
9.
Sex
Male
Female
10.
Marital Status
Single
Married
Divorced
Widowed
Form I-941 12/22/17 N
Page 1 of 15
Where do you want USCIS to send all travel documents for
Part 1. Information About the Entrepreneur
you, and your spouse and dependent children (if applicable)?
(Applicant) (continued)
18.a.
To the U.S. address in Part 1., Item Numbers
11.
Country of Birth
19.a. - 19.f.
18.b.
To a U.S. Embassy or U.S. Consulate at:
12.
Country of Citizenship or Nationality
Name of U.S. Embassy or U.S. Consulate
13.
Date of Last Arrival in the United States (if any)
18.c.
To a Department of Homeland Security (DHS) office
overseas at:
(mm/dd/yyyy)
Name of DHS Office
14.
Current or Last Class of Admission (if any) (for example,
B-1, F-1, H-1B)
Entrepreneur's Current U.S. Mailing Address
15.
If you are present in the United States, other than on the
basis of an Entrepreneur Parole, provide the receipt number
19.a.
In Care Of Name
of your most recent filing with USCIS (if applicable).
19.b.
Street Number
and Name
Provide information about your most recent Form I-94 Arrival-
19.c.
Apt.
Ste.
Flr.
Departure Record, in Item Numbers 16.a. - 16.f. (if any).
16.a. Form I-94 Arrival-Departure Record Number
19.d.
City or Town
19.e.
State
19.f.
ZIP Code
16.b.
Passport Number
Entrepreneur's Current Physical Address
16.c.
Travel Document Number (if any)
20.a.
Street Number
and Name
20.b.
Apt.
Ste.
Flr.
16.d. Country of Issuance for Passport or Travel Document
20.c.
City or Town
16.e. Expiration Date for Passport or Travel Document
20.d.
State
20.e.
ZIP Code
(mm/dd/yyyy)
20.f.
Province
16.f.
Date that Authorized Stay Expired or Will Expire as
Shown on Form I-94 or I-95 (mm/dd/yyyy)
20.g. Postal Code
20.h.
Country
17.a. Have you, or any person included in this application, ever
been in exclusion, deportation, removal, or rescission
proceedings, or are you now in such proceedings?
Entrepreneur's Education
Yes
No
21.
Name of Institution of Higher Learning
If you answered "Yes," to Item Number 17.a., provide
the following information below:
17.b.
Name of the Person in Proceedings
22.
Type of Degree/Major Field of Study
23.
Date Degree Received (mm/dd/yyyy)
Form I-941 12/22/17 N
Page 2 of 15
Part 1. Information About the Entrepreneur
Part 3. Information About Family Members
(Applicant) (continued)
Requesting Parole or Re-Parole with
Entrepreneur
School Address
Entrepreneur's Spouse's Information
24.a.
Street Number
and Name
1.a.
Family Name
24.b.
Apt.
Ste.
Flr.
(Last Name)
1.b.
Given Name
24.c.
City or Town
(First Name)
1.c.
Middle Name
24.d.
State
24.e. ZIP Code
2.
A-Number (if any)
24.f.
Province
A-
24.g.
Postal Code
3.
USCIS Online Account Number (if any)
24.h.
Country
4.
Date of Birth (mm/dd/yyyy)
5.
Country of Birth
Part 2. Biographic Information
1.
Ethnicity (Select only one box)
6.
Country of Citizenship or Nationality
Hispanic or Latino
Not Hispanic or Latino
Entrepreneur's Spouse's Other Names Used
2.
Race (Select all applicable boxes)
White
Provide any other names your spouse has used since birth,
including aliases, maiden names, and nicknames. If you need
Asian
extra space to complete this section, use the space provided in
Black or African American
Part 10. Additional Information.
American Indian or Alaska Native
7.a.
Family Name
Native Hawaiian or Other Pacific Islander
(Last Name)
7.b.
Given Name
3.
Height
Feet
Inches
(First Name)
4.
Weight
Pounds
7.c.
Middle Name
5.
Eye Color (Select only one box)
Entrepreneur's Dependent Children
Black
Blue
Brown
Provide the following information about each child. If you need
Gray
Green
Hazel
extra space to complete this section, use the space provided in
Maroon
Pink
Unknown/Other
Part 10. Additional Information.
6.
Hair Color (Select only one box)
Child 1
Bald (No hair)
Black
Blond
8.a. Family Name
Brown
Gray
Red
(Last Name)
8.b. Given Name
Sandy
White
Unknown/Other
(First Name)
8.c.
Middle Name
Form I-941 12/22/17 N
Page 3 of 15
3.
Country of Citizenship or Nationality
Part 3. Information About Family Members
Requesting Parole or Re-Parole with
Entrepreneur (continued)
4.
Receipt Number (if applicable)
9.
A-Number (if any)
A-
Entrepreneur 2
10.
USCIS Online Account Number (if any)
5.a. Family Name
(Last Name)
5.b. Given Name
11.
Date of Birth (mm/dd/yyyy)
(First Name)
12.
Country of Birth
5.c.
Middle Name
6.
Date of Birth (mm/dd/yyyy)
13.
Country of Citizenship or Nationality
7.
Country of Citizenship or Nationality
8.
Receipt Number (if applicable)
Child 2
14.a. Family Name
(Last Name)
14.b. Given Name
Part 5. Basis of Eligibility - Qualifying Start-Up
(First Name)
Entity and Owners
14.c.
Middle Name
15.
A-Number (if any)
Information About the Qualifying Start-Up Entity
A-
1.
Start-Up Entity Legal Name
16.
USCIS Online Account Number (if any)
Start-Up Entity Address
17.
Date of Birth (mm/dd/yyyy)
2.a.
Street Number
and Name
18.
Country of Birth
2.b.
Apt.
Ste.
Flr.
19.
Country of Citizenship or Nationality
2.c.
City or Town
2.d.
State
2.e.
ZIP Code
3.
Federal Employer Identification Number
Part 4. Information About Additional
Entrepreneurs Requesting or Have Been Granted
Parole or Re-Parole with the Same Start-up
4.
DUNS Number (if any)
Entity
Entrepreneur 1
5.
Trade Name "DBA" (Doing Business As)
1.a. Family Name
(Last Name)
1.b. Given Name
6.
Date Start-Up Entity Established in United States
(First Name)
(mm/dd/yyyy)
1.c.
Middle Name
7.
Number of Full-Time Employees in United States
2.
Date of Birth (mm/dd/yyyy)
Form I-941 12/22/17 N
Page 4 of 15
11.b.
Amount of Qualified Government Award or Grant
Part 5. Basis of Eligibility - Qualifying Start-Up
Entity and Owners (continued)
$
8.
Your Ownership Stake/Percentage of Start-Up Entity
11.c.
Date Qualified Grant or Award Received (mm/dd/yyyy)
%
If you need more space to complete this section, use the
Applying for Initial Parole
space provided in Part 10. Additional Information.
9.
Explanatory Statement. Provide a detailed statement
explaining how you meet the criteria for entrepreneur
Alternative Criteria
parole. Your statement should include an explanation of
your role in the operations of that entity, as well as how
12.a.
Does your start-up entity partially meet one or both of the
your involvement with the start-up entity will advance the
above threshold criteria?
start-up entity's growth and business success such as to
Yes
No
N/A
result in a significant public benefit. You may provide this
If you answered "Yes" to Item Number 12.a., provide
statement in the space provided in Part 10. Additional
the amounts of qualified investment and/or qualified
Information or attach a separate sheet of paper; type or
government award or grant that was received in Item
print your name and startup entity identification number at
Numbers 12.b. - 12.c.
the top of each sheet; indicate the Page Number, Part
Number and Item Number to which your answer refers;
12.b.
Amount of Qualified Investment
and sign and date each sheet.
$
12.c.
Amount of Qualified Government Award or Grant
$
Applying for Re-Parole
13.
Is this the same start-up entity for which you were granted
an initial parole?
Yes
No
If you answered "No" to Item Number 13., explain the
10.a.
Did your start-up entity receive a qualified investment of
current status of the start-up entity for which you were
at least $250,000 within 18 months immediately
granted initial parole in Item Number 14. If you need
preceding the filing of this application?
more space to complete this section, use the space
Yes
No
provided in Part 10. Additional Information.
14.
Explanation
If you answered "Yes" to Item Number 10.a., provide
the amount of qualified investment and date the qualified
investment was received in Item Numbers 10.b. - 10.c.
10.b.
Amount of Qualified Investment
$
10.c.
Date Qualified Investment Received (mm/dd/yyyy)
If you need more space to complete this section, use the
space provided in Part 10. Additional Information.
11.a.
Did your start-up entity receive a qualified government
Re-Parole Criteria
award or grant of at least $100,000 within 18 months
immediately preceding the filing of this application?
Provide evidence that you continue to meet the definition of
Yes
No
entrepreneur and that your business continues to meet the
definition of start-up entity.
If you answered "Yes" to Item Number 11.a., provide
15.
Do you own at least 5% of the shares, or similar type of
the amount of qualified government award or grant and
equity interest, in the start-up entity?
date the qualified government award or grant was
Yes
No
received in Item Numbers 11.b. - 11.c.
Form I-941 12/22/17 N
Page 5 of 15
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