I 131

Application for Travel Document
USCIS
Form I-131
Department of Homeland Security

U.S. Citizenship and Immigration Services
OMB No. 1615-0013

Expires 03/31/2016
Action Block
Receipt
To Be Completed
by an Attorney/
Representative,
if any.
For
USCIS
Use
Only
Fill in box if G-28 is

attached to represent
the applicant.
Document Hand Delivered

By:
Date:
Document Issued
Re-entry Permit (Update
"Mail To" Section)
Refugee Travel Document

(Update "Mail To" Section)
Single Advance Parole
Multiple Advance Parole

Valid Until:
/
/
Mail To
(Re-entry &
Refugee
Only)
/
Attorney State
License Number:
Address in Part 1
US Consulate at:
Intl DHS Ofc at:
Start Here. Type or Print in Black Ink
Part 1. Information About You

1.a. Family Name
(Last Name) Youssef
1.b. Given Name
(First Name) Mina
Other Information
3.
Alien Registration Number (A-Number)

A- 0 8 7 9 7 0 5 4 9
1.c. Middle Name

4.
Physical Address
Egypt
2.a. In Care of Name
5.
Mina Youssef
2.b. Street Number
and Name
2.c. Apt.
Country of Citizenship
Egypt
821 Bergen Ave
Ste.
Flr.
6.
Class of Admission
7.
Gender
8.
Date of Birth
9.
U.S. Social Security Number (if any)
B2
2.d. City or Town
Jersey City
2.e. State NJ
2.f.
2.g. Postal Code
Country of Birth
Zip Code 07306
Male
Female
(mm/dd/yyyy) 09/10/1990
8 0 4 8 9 1 1 6 4
2.h. Province
2.i.
Country USA
Form I-131 03/22/13 N
Page 1 of 5
Part 2. Application Type

1.a.
I am a permanent resident or conditional resident of

the United States, and I am applying for a reentry
permit.
1.b.
I now hold U.S. refugee or asylee status, and I am

applying for a Refugee Travel Document.
1.c.
I am a permanent resident as a direct result of refugee

or asylee status, and I am applying for a Refugee
Travel Document.
1.d.
1.e.
1.f.
2.e. Country of Birth
2.f.
Country of Citizenship
2.g. Daytime Phone Number
2.h. In Care of Name
I am outside the United States, and I am applying for

an Advance Parole Document.
2.i.
I am applying for an Advance Parole Document for a

person who is outside the United States.
Street Number
and Name
2.j.
Apt.
Ste.
Flr.
2.k. City or Town

2.l.
2.a. Family Name

(Last Name)
2.b. Given Name
(First Name)
Physical Address (If you checked box 1.f.)
I am applying for an Advance Parole Document to

allow me to return to the United States after
temporary foreign travel.
If you checked box "1.f." provide the following information

about that person in 2.a. through 2.p.
State
2.m. Zip Code
2.n. Postal Code

2.o. Province
2.c. Middle Name

2.d. Date of Birth
(mm/dd/yyyy)
2.p. Country
Part 3. Processing Information

1.
Date of Intended Departure

(mm/dd/yyyy)
2.
4.a. Have you ever before been issued a reentry permit or

Refugee Travel Document? (If "Yes" give the following
information for the last document issued to you):
Yes
Expected Length of Trip (in days)
3.a. Are you, or any person included in this application, now

in exclusion, deportation, removal, or rescission
proceedings?
Yes
No
4.b. Date Issued
No
(mm/dd/yyyy)
4.c. Disposition (attached, lost, etc.):
3.b. If "Yes", Name of DHS office:
If you are applying for a non-DACA related Advance Parole Document, skip to Part 7; DACA recipients must complete Part 4
before skipping to Part 7.
Form I-131 03/22/13 N
Page 2 of 5
Part 3. Processing Information (continued)

Where do you want this travel document sent? (Check one)
5.
6.
To the U.S. address shown in Part 1 (2.a through

2.i.) of this form.
To a U.S. Embassy or consulate at:
10.b. Street Number

and Name
10.c. Apt.
6.a. City or Town
Ste.
Flr.
10.d. City or Town
6.b. Country
7.
10.e. State
To a DHS office overseas at:
10.f. Zip Code
7.a. City or Town
10.g. Postal Code
7.b. Country
10.h. Province
If you checked "6" or "7", where should the notice to pick up

the travel document be sent?
10.i. Country
8.
To the address shown in Part 2 (2.h. through 2.p.)

of this form.
10.j. Daytime Phone Number
9.
To the address shown in Part 3 (10.a. through 10.i.)

of this form.:
Part 4. Information About Your Proposed Travel

1.a. Purpose of trip. (If you need more space, continue on a
separate sheet of paper.)
1.b. List the countries you intend to visit. (If you need more
space, continue on a separate sheet of paper.)
Attend my sister's wedding
Egypt
Part 5. Complete Only If Applying for a Re-entry Permit

Since becoming a permanent resident of the United States (or
during the past 5 years, whichever is less) how much total time
have you spent outside the United States?
1.a.
1.b.
1.c.
less than 6 months

6 months to 1 year
1 to 2 years
Form I-131 03/22/13 N
1.d.
1.e.
1.f.
2 to 3 years
3 to 4 years
more than 4 years
2.
Since you became a permanent resident of the United

States, have you ever filed a Federal income tax return as
a nonresident or failed to file a Federal income tax return
because you considered yourself to be a nonresident? (If
"Yes" give details on a separate sheet of paper.)
Yes
No
Page 3 of 5
Part 6. Complete Only If Applying for a Refugee Travel Document

1.
3.c. Applied for and/or received any benefit from such country
(for example, health insurance benefits)?
Country from which you are a refugee or asylee:
Yes
If you answer "Yes" to any of the following questions, you
must explain on a separate sheet of paper. Include your
Name and A-Number on the top of each sheet.
2.
Do you plan to travel to the country

named above?
Yes
No
No
Since you were accorded refugee/asylee status, have you, by

any legal procedure or voluntary act:
4.a. Reacquired the nationality of the
country named above?
Yes
No
Since you were accorded refugee/asylee status, have you ever:
4.b. Acquired a new nationality?
Yes
No
3.a. Returned to the country named

above?
4.c. Been granted refugee or asylee status

in any other country?
Yes
No
Yes
No
3.b. Applied for and/or obtained a national passport, passport

renewal, or entry permit of that country?
Yes
No
Part 7. Complete Only If Applying for Advance Parole

On a separate sheet of paper, explain how you qualify for an
Advance Parole Document, and what circumstances warrant
issuance of advance parole. Include copies of any documents
you wish considered. (See instructions.)
1.
How many trips do you intend to use this document?

One Trip
More than one trip
If the person intended to receive an Advance Parole Document

is outside the United States, provide the location (City or Town
and Country) of the U.S. Embassy or consulate or the DHS
overseas office that you want us to notify.
2.a. City or Town
4.b. Street Number

and Name
4.c. Apt.
Ste.
Flr.
4.d. City or Town

4.e. State
4.f.
Zip Code
4.g. Postal Code

4.h. Province
2.b. Country
If the travel document will be delivered to an overseas office,

where should the notice to pick up the document be sent?:
3.
To the address shown in Part 2 (2.h. through 2.p.)

of this form.
4.
To the address shown in Part 7 (4.a. through 4.i.)

of this form.
Form I-131 03/22/13 N
4.i.
Country
4.j.
Daytime Phone Number
Page 4 of 5
Part 8. Signature of Applicant (Read the information on penalties in the Form instructions before completing
this Part.) If you are filing for a Re-entry Permit or Refugee Travel Document, you must be in the United States
to file this application.
1.a. I certify, under penalty of perjury under the laws of the
United States of America, that this application and the
evidence submitted with it is all true and correct. I
authorize the release of any information from my records
that U.S. Citizenship and Immigration Services needs
to determine eligibility for the benefit I am seeking.
Signature of Applicant
1.b. Date of Signature (mm/dd/yyyy) 02/05/2015

2.
Daytime Phone Number
201
365 - 85 93
NOTE: If you do not completely fill out this form or fail to

submit required documents listed in the instructions, your
application may be denied.
Part 9. Information About Person Who Prepared This Application, If Other Than the Applicant
NOTE: If you are an attorney or representative, you must
submit a completed Form G-28, Notice of Entry of Appearance
as Attorney or Accredited Representative, along with this
application.
Preparer's Contact Information

4.
Preparer's Full Name

Provide the following information concerning the preparer:
Preparer's Daytime Phone Number
5.
Extension
Preparer's E-mail Address (if any)
1.a. Preparer's Family Name (Last Name)
Declaration
1.b. Preparer's Given Name (First Name)
2.
Preparer's Business or Organization Name
To be completed by all preparers, including attorneys and

authorized representatives: I declare that I prepared this benefit
request at the request of the applicant, that it is based on all the
information of which I have knowledge, and that the
information is true to the best of my knowledge.
Preparer's Mailing Address
6.a. Signature
of Preparer
3.a. Street Number

and Name
6.b. Date of Signature (mm/dd/yyyy)
3.b. Apt.
Ste.
Flr.
NOTE: If you require more space to provide any additional
information, use a separate sheet of paper. You must include
your Name and A-Number on the top of each sheet.
3.c. City or Town

3.d. State
3.f.
3.e. Zip Code
Postal Code
3.g. Province
3.h. Country
Form I-131 03/22/13 N
Page 5 of 5

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What types of travel documents can be applied for using this form?

What types of travel documents can be applied for using this form?

Application for Travel Document

Department of Homeland Security

OMB No. 1615-0013

Fill in box if G-28 is

Document Hand Delivered

Refugee Travel Document

Single Advance Parole

Multiple Advance Parole

Start Here. Type or Print in Black Ink

Part 1. Information About You

Alien Registration Number (A-Number)

1.c. Middle Name

2.a. In Care of Name

821 Bergen Ave

U.S. Social Security Number (if any)

2.d. City or Town

2.g. Postal Code

Zip Code 07306

Form I-131 03/22/13 N

Part 2. Application Type

I am a permanent resident or conditional resident of

I now hold U.S. refugee or asylee status, and I am

I am a permanent resident as a direct result of refugee

2.e. Country of Birth

2.g. Daytime Phone Number

2.h. In Care of Name

I am outside the United States, and I am applying for

I am applying for an Advance Parole Document for a

2.k. City or Town

2.a. Family Name

Physical Address (If you checked box 1.f.)

I am applying for an Advance Parole Document to

If you checked box "1.f." provide the following information

2.m. Zip Code

2.n. Postal Code

2.c. Middle Name

Part 3. Processing Information

Date of Intended Departure

4.a. Have you ever before been issued a reentry permit or

Expected Length of Trip (in days)

3.a. Are you, or any person included in this application, now

4.b. Date Issued

4.c. Disposition (attached, lost, etc.):

3.b. If "Yes", Name of DHS office:

Form I-131 03/22/13 N

Part 3. Processing Information (continued)

To the U.S. address shown in Part 1 (2.a through

10.b. Street Number

6.a. City or Town

10.d. City or Town

10.a. In Care of Name

To a DHS office overseas at:

10.f. Zip Code

7.a. City or Town

10.g. Postal Code