Physical presence worksheet

Applicant Name:
Date of Birth:
Absences from the U.S. Worksheet for Deferred Action of Childhood Arrivals (DACA)
I first entered the United States under the name of:
(First name, middle name, last name)
I first arrived on: in:
(month, day, year) (city, state)
Immigration status at first entry: Worksheet Page of
Travel since that date:
Departure Date
from U.S.
Place of Departure Reason for Departure Date of Return to
U.S.
Port of Entry
Immigration status at
entry (Visa, EWI, etc.)

Applicant Name:
Date of Birth:
Departure Date
from U.S.
Place of Departure Reason for Departure Date of Return to
U.S.
Port of Entry
Immigration status at
entry (Visa, EWI, etc.)